The shoulder is the most mobile joint in the body — and it is precisely this great mobility that makes it susceptible to irritation and overuse. Shoulder pain usually originates in the tendons, the bursa, or from wear and tear, less commonly from the joint itself. When the pain occurs — when lifting your arm, at night while lying down, or during certain movements — often provides a good indication of the cause.
Possible causes
Tendon irritation and impingement
Very common: the tendons beneath the shoulder roof become pinched and irritated during certain movements. Typical is pain when lifting the arm sideways and at night when lying on the shoulder.
Bursitis
The bursa, which cushions the tendons, can become inflamed due to overuse. This manifests as movement-related, often burning pain on the outer side of the shoulder.
Wear and tear (osteoarthritis)
Age-related degradation of the joint cartilage causes load-dependent pain and progressively restricted mobility. It cannot be reversed, but can be well managed.
Muscle tension and poor posture
Tense neck and shoulder muscles, for example from screen work or stress, can radiate into the shoulder. Such complaints usually improve with movement and relaxation.
Typical steps at the doctor's office
- 1The doctor will ask which movements cause pain and whether the pain occurs at night, then perform various movement tests to determine which structure is affected. This examination already provides a large part of the diagnosis.
- 2Depending on the suspected cause, imaging may be added: ultrasound shows tendons and bursa well, X-ray shows the bone and joint, and MRI shows the tendons in detail if needed. Not every shoulder requires an MRI right away.
- 3Treatment almost always begins conservatively: targeted physiotherapy to strengthen and centre the shoulder, temporary relief, and anti-inflammatory measures as prescribed by your doctor if needed. Surgery is only considered in certain cases.
What you can do yourself
- Avoid overhead movements that trigger the pain during the acute phase — but keep the shoulder moving within the pain-free range.
- Heat relaxes tense muscles; in case of acute irritation, cooling may also provide short-term relief.
- Targeted exercises to strengthen the shoulder-stabilising muscles are the most effective long-term measure — ideally under professional guidance.
- At night, pay attention to a shoulder-friendly sleeping position and avoid lying on the painful side.
A doctor's visit is advisable if the pain persists for longer than one to two weeks, occurs at night, increasingly restricts mobility, or keeps recurring. It is also worth having it checked if you can barely lift your arm.
Frequently asked questions
- Why does the shoulder hurt especially at night?
- Night-time pain, particularly when lying on the shoulder, is typical of tendon irritation or bursitis. When lying down, the relieving effect of gravity is absent, and the irritated structures are subjected to greater stress.
- Should I immobilise the shoulder?
- Only briefly and in moderation. Prolonged immobilisation can lead to painful stiffening. Movement within the pain-free range and targeted exercises are more important for most shoulder problems.
- Which doctor should I see?
- For strain-related and wear-related pain, orthopaedics is responsible. Your GP can assess the complaints well, initiate initial measures, and refer you onwards if needed.
Not sure whether you should go or whom to see? Describe your symptoms — we'll find the right practice in your area.