Shoulder pain is one of the most common complaints in orthopedics. There are many causes: from simple overuse to serious tendon tears. Understanding the cause is the first step to proper treatment.

1. Rotator cuff injury

Four muscles and their tendons stabilise the shoulder. Tears can be traumatic or age-related; after 60, partial tears are often found in people without pain. Pain on raising the arm, weakness, night pain on the affected side. Treatment: for age-related tears, exercise therapy first, injections during flare-ups. A fresh traumatic tear in an active person should be seen by an orthopaedic specialist within the first weeks: tendon repair gives better results if not delayed.

2. Frozen shoulder (adhesive capsulitis)

The joint capsule becomes inflamed and thickened, and movement is gradually lost. The condition passes through three phases and lasts 1–3 years; it is more common with diabetes and thyroid disease. Treatment: mobility exercises, pain relief, a corticosteroid injection in the early phase, sometimes hydrodilatation. In most people movement eventually returns fully or almost fully.

3. Impingement syndrome

Pain when raising the arm through an arc of 60–120°, worse with overhead work. Treatment: an exercise programme for the shoulder-blade and cuff muscles, NSAIDs, an injection if needed. Surgery (acromioplasty) showed no advantage in sham-controlled trials, so it is rarely performed.

4. Calcific tendinitis

Calcium deposits in a cuff tendon; during resorption the pain can be severe. Treatment: shockwave therapy, ultrasound-guided lavage of the deposit, an injection; in many people the deposits resorb on their own over time.

5. Shoulder osteoarthritis

Cartilage wear after injury, instability or with age. Treatment: exercise and pain relief; injections reduce pain but do not restore cartilage. With severe pain and limited movement, joint replacement — anatomical or reverse — is discussed.

6. Shoulder instability

After a first dislocation, young people have a high risk of further dislocations. Treatment: strengthening the shoulder and shoulder-blade muscles; after recurrent dislocations, especially in young people and athletes, surgery (Bankart or Latarjet stabilisation) is more often recommended. Injections do not strengthen the capsule or ligaments.

7. Shoulder bursitis

Inflammation of the subacromial bursa, often together with impingement. Treatment: offloading, NSAIDs, exercises and, if needed, a corticosteroid injection (no more than 2–3 times a year).

When to see a doctor

Urgently — after an injury with sudden arm weakness or a visible deformity. Routinely — if pain lasts more than 4–6 weeks, disturbs sleep or prevents raising the arm. More on conditions in the shoulder section.

Frequently asked questions

What are the most common causes of shoulder pain?

Subacromial pain and rotator cuff tendinopathy, frozen shoulder, calcific tendinitis, osteoarthritis and pain referred from the neck. The cause is clarified by examination, ultrasound and MRI.

Why does my shoulder hurt at night?

Night pain is typical of rotator cuff problems, bursitis and frozen shoulder, because lying down compresses the tendons and bursa. See the article on shoulder pain at night for more.

When does shoulder pain need urgent attention?

If left shoulder pain comes with chest pain or breathlessness, after an injury with deformity or inability to lift the arm, and with fever and a hot swollen joint.

How does RegenPAS help organise treatment?

RegenPAS is a patient service centre in Munich, not a clinic. We review your images and symptoms and send a request to several partner clinics at once. Clinics that can accept you send their own conditions and price; prices differ between clinics, and you choose the option that suits you. The coordinator replies within 24 hours, and a clinic physician’s preliminary opinion follows in 1–3 business days. We then arrange the appointment, visa invitation, interpreter, transfers and accommodation. Treatment decisions are made by the clinic physician. Contact a coordinator.

How much does treatment cost and how long do I need to stay in Munich?

The cost depends on the method, the diagnostics needed and the clinic itself: prices differ between clinics. We request offers from several clinics and send you their conditions and quotes so you can compare. Price guidance is on the treatment cost page. For an outpatient procedure, 2–3 days in Munich are usually enough: examination, procedure and follow-up visit.

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Who it is not suitable for and possible risks

Contraindications

  • Active infection — at the injection site or systemic, with fever.
  • Active cancer or ongoing chemotherapy.
  • Blood clotting disorders or a low platelet count. Anticoagulants are discussed with the physician.
  • Pregnancy and breastfeeding — the procedure is usually postponed.
  • A corticosteroid injection into the same area in recent weeks.
  • A complete tendon or ligament rupture with loss of function — surgical repair is usually needed.

Possible risks

  • Pain and swelling at the injection site for 1–3 days.
  • Bruising where blood or fat tissue is taken.
  • Rarely, infection. The procedure is therefore performed under sterile conditions with ultrasound or X-ray guidance.
  • The effect may be absent or smaller than expected.

If any of these apply to you, mention it in your request. The coordinator will check with the clinic physician whether treatment is possible. Contact a coordinator.

Scientific evidence

Studies of regenerative methods show mixed results. Clinic physicians rely on research including the following:

  1. Karjalainen TV et al. Surgery for rotator cuff tears. Cochrane Database Syst Rev, 2019.
  2. Vandvik PO et al. Subacromial decompression surgery for adults with shoulder pain: a clinical practice guideline. BMJ, 2019.

Next steps: Treatment methods · Treatment cost · How treatment in Germany is organised · Contact a coordinator

Clinic and method matching — free of charge

Describe your case and attach your MRI report. We will identify clinics that use the relevant methods and forward your request to them. No obligation; we reply within 24 hours.

Send a request