Shoulder pain that won't go away: causes and treatment

Why shoulder pain hangs around

The NHS advises seeing a GP or other health professional if the pain is getting worse, hasn't improved after two weeks, or it is very hard to move your arm (NHS, n.d.a). In our experience, pain that lingers past that point usually falls into one of three groups. Working out which one you have matters, because they are treated differently.

Rotator cuff related pain

The rotator cuff is a group of four muscles and tendons that hold the ball of the shoulder in its socket and help you lift and turn the arm. Pain from this area, often called subacromial pain, is the most common type of shoulder pain (BESS, n.d.).

Typical signs are pain over the outside and upper part of the arm, pain lifting the arm, especially overhead or across the body, some loss of strength, and sometimes clicking or catching (NHS Tayside, 2015). It can come on gradually or start suddenly, and a sudden start is more common with a tear (NHS Tayside, 2015). Rotator cuff pain rarely spreads below the elbow (Humber and North Yorkshire Health and Care Partnership, 2025).

Frozen shoulder

If the shoulder is getting stiffer as well as more painful, and you can't turn the arm outwards even when someone else moves it for you, frozen shoulder is more likely. Stiffness turning the arm outwards is one of the clinical clues that separates it from a rotator cuff problem (Humber and North Yorkshire Health and Care Partnership, 2025). We have covered the stages and timescales in detail in how long does frozen shoulder last, so we won't repeat that here.

Pain referred from the neck

Not all shoulder pain starts in the shoulder. The neck and shoulder can each refer pain to the other, and the two problems can exist together. One study notes that painful shoulder impingement is found in up to 24% of people with a trapped nerve in the neck (Khan et al., 2021). The same authors suggest mapping where the pain goes, whether it spreads to or beyond the elbow, and whether there is numbness, to help tell the two apart (Khan et al., 2021). This is why a good shoulder assessment always checks the neck too.

Shoulder pain treatment: what actually helps

Exercise comes first

The British Elbow and Shoulder Society (BESS) recommends physiotherapy or other non surgical treatment as the first line for rotator cuff related pain. Exercise reduces pain in the short term and improves function in both the short and long term, and hands on treatment may help in the early phase (Pandey and Singh, 2025).

The research is honest about what it can't yet tell us. It isn't clear which type of programme, how heavy the loading, or how much supervision works best (Pandey and Singh, 2025). In a large UK trial of 708 adults with rotator cuff problems, a progressive exercise programme of up to six physiotherapy sessions did no better over 12 months than one session of good quality advice and a home programme (Hopewell et al., 2021). For us, the takeaway is that a clear explanation and a plan you can follow at home do a lot of the work. Extra sessions are most useful when you are stuck, unsure how hard to push, or your symptoms don't fit the usual pattern.

BESS suggests people on a specific programme should be showing real improvement by about three months, and that failure to improve after 12 weeks of non surgical care should prompt a referral for further assessment (Pandey and Singh, 2025).

Simple things you can do now

The NHS advises keeping the shoulder gently moving rather than resting it completely, avoiding the movements that make it worse, using painkillers such as paracetamol or ibuprofen to help you keep moving, and trying heat or cold for up to 20 minutes at a time (NHS, n.d.a).

When an ultrasound scan or injection is considered

Scans

You don't need a scan to diagnose most rotator cuff pain or to start treatment (Pandey and Singh, 2025). Imaging becomes useful when pain isn't settling, when the diagnosis is uncertain, or when a tear is suspected. Ultrasound is a low cost and effective first test in experienced hands, and it can be used to look for rotator cuff tears in people with ongoing symptoms (Pandey and Singh, 2025). We offer diagnostic ultrasound scans from £80 when we think the result will change the plan.

Steroid injections

BESS suggests that if there is no improvement by six to eight weeks, a single subacromial steroid injection can be considered as a shared decision (Pandey and Singh, 2025). The evidence shows a short lived improvement in pain, function and movement, usually under 12 weeks, with no effect on long term outcome. Repeat injections add no benefit over a single one (Pandey and Singh, 2025). The UK trial above found the same, with no long term benefit from the injection (Hopewell et al., 2021).

So we see an injection as a way to calm things down enough to get on with the exercise, not a fix on its own. A steroid is a prescription only medicine, so it is given only after an assessment by a qualified prescriber. At The Treatment Table every steroid injection is given under live ultrasound guidance and costs £150, including the scan guidance and the medication. To be fair to the evidence, BESS found no clear difference in outcome between ultrasound guided and unguided injections for this problem (Pandey and Singh, 2025). The benefit of guidance is accuracy and seeing exactly where the medicine goes. Our cortisone injection cost guide explains what to check before booking anywhere.

Seeing a shoulder physiotherapist: what to expect

If you are searching for shoulder pain treatment near me, here is what a first appointment with us involves. We ask how the pain started, what makes it better and worse, and how it affects sleep, work and sport. We then examine the shoulder and neck, comparing how far you can move the arm with how far it moves when we move it for you, and testing strength.

By the end you should know what we think is going on, roughly how long it is likely to take, and what you can do at home. If we think a scan, an injection or a referral elsewhere is the right next step, we will say so and explain why.

Frequently asked questions

Why won't my shoulder pain go away?

The most common reasons are a rotator cuff problem, a frozen shoulder, or pain referred from the neck. Shoulder pain is often slow to settle. The NHS says it usually takes about two weeks of self-care before pain starts to ease and that recovery can take six months or longer. If it is getting worse or hasn't improved after two weeks, get it assessed.

What is the best treatment for rotator cuff pain?

UK guidance recommends physiotherapy and exercise as the first treatment for rotator cuff related pain, because exercise reduces pain and improves function. A large UK trial found one session of good advice with a home programme did as well over a year as up to six physio sessions. A steroid injection can be considered if there is no improvement after six to eight weeks.

Do I need a scan for shoulder pain?

Usually not at first. UK shoulder guidance says imaging isn't needed to diagnose most rotator cuff pain or to start treatment. A scan becomes useful if the pain isn't settling, the diagnosis is unclear, or a tear is suspected. Ultrasound is a low cost and effective first test in experienced hands. Our diagnostic ultrasound scans start from £80.

Will a steroid injection fix my shoulder?

An injection can give short-term relief, usually for under 12 weeks, but research shows no long-term benefit for rotator cuff pain and repeat injections add nothing over a single one. It works best as a way to calm the pain so you can do your exercises. A steroid is prescription only, so it is given after assessment by a qualified prescriber.

When is shoulder pain an emergency?

Call 999 if shoulder, arm, neck or jaw pain comes with tight or squeezing chest pain or severe breathlessness, as this can be a heart attack. Get urgent help from a GP or NHS 111 if the pain followed a fall or injury, you can't move the arm, the shoulder has changed shape, you have numbness that won't go away, or you feel feverish and unwell.