Causes of shoulder pain

Rotator Cuff Pathology (70% of all shoulder pain)

Rotator Cuff Tendinitis

Inflammation of the tendons of the supraspinatus, infraspinatus, teres minor, and subscapularis muscles. Develops with repetitive overhead arm movements (painters, tennis players, swimmers). Pain with arm abduction, especially in the 60-120° range («painful arc»). Nighttime pain is a typical sign.

→ Rotator Cuff Treatment using a regenerative method

Partial and Complete Rotator Cuff Tear

Acute (from falling on outstretched arm, sudden jerk) or chronic (degenerative — after age 50). Partial tear: pain and weakness with abduction. Complete tear: inability to raise arm, «falling arm sign». MRI data shows 30% of people over 60 have asymptomatic tears.

Impingement Syndrome (Subacromial)

Compression of rotator cuff tendons and subacromial bursa between humeral head and acromion during arm elevation. Causes: acromion shape (hooked), osteophytes, ligament thickening. Pain when raising arm above horizontal.

→ Impingement Syndrome Treatment

Capsule and Ligament Pathology

Adhesive Capsulitis (Frozen Shoulder)

Fibrotic thickening and fusion of joint capsule. Three phases: «freezing» (3-9 months — increasing pain), «frozen» (4-12 months — minimal pain but severe motion restriction), «thawing» (6-24 months — gradual recovery). More common in women 40-60 years old; diabetes increases risk 5-fold.

→ Frozen Shoulder Treatment

Shoulder Joint Instability

After shoulder dislocation or congenital hyperelasticity. Sensation of shoulder «popping out», apprehension with certain movements. Labral injury (labrum) — Bankart lesion.

→ Shoulder Instability Treatment

Other Causes

Calcific Tendinitis

Calcium crystal deposition in rotator cuff tendons (most often supraspinatus). Severe pain during resorption phase — patient cannot move arm. X-ray shows white calcific deposits.

→ Calcific Tendinitis Treatment

Shoulder Osteoarthritis (Omarthrosis)

Degeneration of glenoid and humeral head cartilage. Crepitus, motion restriction, pain. Less common than knee or hip osteoarthritis, but significantly reduces quality of life.

→ Shoulder Osteoarthritis Treatment

Shoulder Bursitis

Inflammation of subacromial or subdeltoid bursa. Pain with abduction, tenderness to palpation. Often accompanies rotator cuff tendinitis and impingement.

→ Shoulder Bursitis Treatment

Acromioclavicular Joint Osteoarthritis

Pain at top of shoulder, with cross-body adduction (arm across chest to opposite shoulder). Common MRI finding after age 50.

Referred Pain (Cervical Spine)

C5-C6, C6-C7 disc herniations can present as shoulder pain without clear joint pathology. Important: shoulder pain + finger numbness → cervical spine MRI mandatory.

Diagnosis of Shoulder Pain

MRI of the Shoulder Joint

Visualizes the rotator cuff, labrum, cartilage, joint capsule, bone marrow. For suspected SLAP injury or Bankart lesion, MR arthrography (with intra-articular contrast) is recommended.

Ultrasound of the Shoulder Joint

Dynamic examination — allows assessment of tendons during movement. Detects rotator cuff tears, bursitis, effusion. Sensitivity for full-thickness tears — 95%, for partial tears — 70%.

X-ray

In 2 projections + axial. For evaluation: acromion shape (Bigliani I-III), calcific deposits, osteoarthritis, humeral head position (high-riding — with massive cuff tear).

Clinical Tests

Neer and Hawkins tests (impingement), Jobe test (supraspinatus), lift-off test (subscapularis), Speed test (biceps), apprehension test (instability). Combination of tests provides accuracy up to 85%.

How it is treated: the cause comes first

Treatment depends on the cause of the pain, so it starts with an examination and, if needed, imaging — X-ray, ultrasound or MRI. The same pain can be caused by osteoarthritis or by a tendon, nerve or disc problem.

Most patients are helped by conservative treatment: exercise therapy, load management, short courses of painkillers and sometimes injections. Regenerative methods (PRP, cell preparations) are discussed once the diagnosis is known and there is at least limited evidence for it; no method guarantees a result.

We send a description of your case and your images to several partner clinics. The clinic doctors give a preliminary opinion, suggest a plan and quote a price, and we help you compare the options.

Conditions of the Shoulder Joint

Rotator Cuff

Tendon injury. Pain with abduction, night pain, weakness.

Frozen Shoulder

Adhesive capsulitis. Progressive limitation of all movements.

Shoulder Impingement Syndrome

Tendon compression under acromion. Pain with arm elevation.

Calcific Tendinitis

Calcium deposition in tendons. Severe pain during resorption.

Shoulder Osteoarthritis

Cartilage degeneration. Crepitus, limited motion, pain.

Shoulder Instability

Recurrent dislocation, Bankart lesion. Sensation of "popping out".

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 · Shoulder pain at night

Questions about Shoulder Pain

Why does the shoulder hurt when raising the arm?

Most common causes: shoulder impingement syndrome (tendon compression under acromion), tendinitis or partial rotator cuff tear, calcific tendinitis. Pain occurs in the 60-120° abduction range — "painful arc".

What is Frozen Shoulder and how is it treated?

Adhesive capsulitis is a fibrotic adhesion of the joint capsule. Three phases: freezing, frozen, and thawing. The cycle lasts 12-36 months. Regenerative treatment accelerates the thawing phase 2-3 times faster: CGF reduces inflammation, MFAT restores the capsule.

Can a rotator cuff tear be repaired without surgery?

With partial tears and tendinopathy — yes. Regenerative treatment delivers CGF and stem cells to the damaged tendon area. For complete tears > 3 cm, arthroscopic reconstruction is recommended combined with regenerative methods biological stimulation.

What imaging is needed for shoulder pain?

MRI of the shoulder joint is the gold standard. It visualizes the rotator cuff, cartilage, labrum, and joint capsule. Ultrasound is used for dynamic assessment of tendons. X-ray is used to detect calcifications and osteoarthritis.

Why does shoulder pain worsen at night?

Night pain is a characteristic sign of rotator cuff pathology. When lying down, pressure on the inflamed tendon increases. Night pain is also typical for calcific tendinitis and adhesive capsulitis.