Shoulder pain: diagnosis and treatment in Lisbon and Almada

The most common causes

• Rotator cuff tendinopathy (supraspinatus): pain on the outside of the arm when raising it, especially overhead, and pain when lying on the shoulder.

• Subacromial impingement: pain through part of the movement when lifting the arm out to the side.

• Adhesive capsulitis ("frozen shoulder"): progressive stiffness in all directions and night pain.

• Acromioclavicular osteoarthritis: pain on top of the shoulder when bringing the arm across the body.

• Pain coming from the neck: pain running down the arm, sometimes with tingling in the hand.

When to seek urgent help

• Sudden loss of strength to lift the arm after a fall.

• Visible deformity or suspected dislocation.

• A hot, swollen shoulder with fever.

• Left shoulder pain with shortness of breath, chest pain or sweating: call 112.

Treatment

Most shoulder pain improves with a well-targeted exercise plan. The aim is to restore movement and strengthen the muscles that control the shoulder blade and shoulder:

• Physiotherapy with progressive loading, in one-to-one sessions, to correct the imbalance that leads to impingement between the tendons and bone.

• Ultrasound-guided procedures when pain is severe or not improving: they give a window of relief so rehabilitation can go ahead. In adhesive capsulitis, ultrasound-guided hydrodilatation may be indicated.

• Movement analysis for people who play overhead sports: swimming, tennis, padel, volleyball or strength training.

Frequently asked questions about shoulder pain

Why does my shoulder hurt more at night?

Lying on the shoulder compresses the inflamed tendons, and at night there is less movement to ease stiffness. It is common in rotator cuff tendinopathy and adhesive capsulitis.

Do I need an ultrasound or an MRI?

Not always. Ultrasound performed by the doctor shows the tendons in motion; MRI is kept for cases that don't improve or when a tear is suspected.

Can I keep going to the gym?

In most cases, yes, with adjustments. Your physiotherapist will tell you which exercises to keep, adapt or pause for now.

How long is recovery?

It depends on the cause. Tendinopathies usually improve over a few weeks to a few months of exercise; adhesive capsulitis is slower.

Will my health insurance cover it?

We are a private practice, but most insurance policies with reimbursement cover will refund part of the cost. See how in Insurance and reimbursements.

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