What is chronic shoulder pain ?

Chronic shoulder pain is pain in or around the shoulder that persists for more than three months.

It may develop gradually over time or follow an injury or surgery. The pain can range from a dull ache to severe pain that interferes with sleep, work, sport, and everyday activities such as dressing, reaching overhead, or lifting objects.

The shoulder is one of the most mobile joints in the body. It relies on a complex combination of muscles, tendons, ligaments, bursae, and the joint capsule to provide stability and movement.

Pain can arise from any of these structures, as well as from the neck or the nervous system.

Symptoms

  • Pain when reaching overhead or behind your back
  • Difficulty lifting or carrying objects
  • Pain at night, particularly when lying on the affected side
  • Stiffness and reduced range of movement
  • Weakness of the shoulder or arm
  • Clicking, catching, or a feeling of instability in some cases

Symptoms can develop gradually or after a sudden injury or repetitive strain.

Common causes

  • Rotator cuff tendinopathy (wear and degeneration of the shoulder tendons)
  • Rotator cuff tears (partial or full-thickness tears)
  • Subacromial pain syndrome (previously called shoulder impingement syndrome)
  • Subacromial bursitis
  • Frozen shoulder (adhesive capsulitis)
  • Shoulder osteoarthritis
  • Acromioclavicular (AC) joint arthritis
  • Long head of biceps tendinopathy or instability
  • Calcific tendinitis
  • Shoulder instability (following dislocations or ligament injuries)
  • Labral tears (including SLAP lesions)
  • Post-traumatic shoulder pain (following fractures or soft tissue injuries)
  • Persistent pain after shoulder surgery (chronic post-surgical pain)
  • Myofascial pain syndrome involving the shoulder girdle muscles
  • Referred pain from the neck (cervical radiculopathy or cervical facet joints)
  • Nerve-related pain, including suprascapular or axillary nerve entrapment (less common)
  • Inflammatory arthritis, such as rheumatoid arthritis or polymyalgia rheumatica
  • Central sensitisation or nociplastic pain, where the nervous system becomes over-responsive despite minimal ongoing tissue damage

Diagnosis

      Diagnosis is based on:

  • Clinical examination: Your doctor will assess shoulder movement, tenderness, and signs of impingement.
  • Imaging: An ultrasound or MRI may be used to confirm bursitis and rule out rotator cuff tears or other causes of pain.

At PainClinicNI.com, we use a combination of clinical expertise and imaging to ensure an accurate diagnosis.

Treatment

We can offer the following treatment options:

  • Subacromial bursa injection – An ultrasound-guided injection of local anaesthetic and corticosteroid into the subacromial bursa to reduce inflammation and relieve pain associated with bursitis or subacromial pain syndrome.
  • Suprascapular nerve block – An ultrasound-guided injection around the suprascapular nerve to reduce pain arising from conditions such as rotator cuff disease, shoulder osteoarthritis, frozen shoulder, or persistent shoulder pain after surgery. 
  • Pulsed Radiofrequency (PRF) of the suprascapular nerve – A minimally invasive, non-destructive procedure that delivers short pulses of radiofrequency energy to modulate pain signalling without damaging the nerve. 
  • Radiofrequency denervation (RF ablation) – In carefully selected patients with severe, persistent shoulder pain who are not suitable for surgery or who continue to experience pain despite other treatments, radiofrequency denervation of the articular sensory nerves supplying the shoulder may be considered as a palliative treatment.

Aftercare Advice

  • You will be observed briefly and can usually go home the same day.
  • Avoid driving for 24 hours.
  • Pain may worsen temporarily before improving — use ice packs and simple painkillers if needed.
  • Resume activities gradually; avoid high-impact activity for a few days.
  • A follow-up appointment will help assess the effectiveness of the injection and plan further treatment if required.

When to Seek Medical Attention

Please attend A&E immediately if you experience:
• Fever, chills, or signs of infection at the injection site
• New or worsening leg numbness or weakness
• Loss of bladder or bowel control
• Severe or ongoing back pain not relieved by usual medication