Rotator cuff related shoulder pain is pain felt on the outside of the upper arm, usually when lifting the arm, that comes from the rotator cuff tendons and the tissues around them. It used to be called impingement. It is the most common cause of shoulder pain, and most people improve with exercise, load management and time.
Also known as subacromial pain, shoulder impingement, rotator cuff tendinopathy, subacromial bursitis
Symptoms
- Ache on the outside of the upper arm or shoulder
- Pain when lifting the arm out to the side or overhead
- Pain lying on the affected side at night
- Pain reaching behind your back or into a coat sleeve
- A feeling of weakness when lifting, often because of pain
Causes and risk factors
- A rise in shoulder load, such as decorating, gardening, a new sport or gym work
- Repeated overhead work
- Getting older, as the tendons change with age
- Reduced strength or conditioning around the shoulder
What the evidence says helps
- Exercise is the main treatment. A 2024 review found that specific, progressive shoulder exercise programmes reduced disability a little more than general exercise.2
- A Cochrane review found that exercise and manual therapy give results that may be similar to steroid injection or surgery, although the quality of this evidence is low. Side effects are usually mild.3
- A steroid injection may ease pain in the short term (up to about 8 weeks). Evidence does not show extra benefit beyond that compared with a numbing injection alone.6
- High-quality trials, including the UK CSAW trial, found that subacromial decompression surgery gave no meaningful benefit over placebo surgery. This operation is not supported for this problem.45
Things you can try at home
- Keep the arm moving within comfortable limits. Complete rest tends to slow recovery.
- Reduce, rather than stop, the activities that flare it up, then build back gradually.
- Do your shoulder strengthening exercises little and often, accepting mild discomfort that settles by the next day.
- Try sleeping with a pillow under the sore arm, or on the other side.
- Simple pain relief from a pharmacist can help you stay active.
When to get urgent help
Contact your GP urgently, call NHS 111, or call 999 in an emergency if you have:
- A visible deformity, severe pain or being unable to move the arm after a fall or blow: go to A&E or an urgent treatment centre.
- A hot, red, swollen shoulder with fever or feeling generally unwell: get same-day help from your GP or NHS 111, as this can signal a joint infection.
- Shoulder pain that comes with chest pain, tightness, breathlessness, sweating or feeling sick: call 999, as this can be a heart problem.
- Shoulder pain with unexplained weight loss, a new lump, or a past history of cancer: see your GP urgently.
- New weakness, numbness or pins and needles spreading down the arm, or loss of feeling in the hand: see your GP urgently or call NHS 111.
How Apollo can help
Our osteopaths and clinical exercise team start with a thorough assessment to understand your shoulder, your goals and what is driving your pain. We explain what is going on in plain language, use hands-on care where it is appropriate, and build a progressive strengthening and load-management plan around your work and hobbies. If you need imaging, an injection or a specialist opinion, we will write to your GP to refer you on.
No GP referral needed. Clinics in Sheringham, Coltishall and Norwich.
Related reading
Frequently asked questions
Is shoulder impingement the same as rotator cuff related shoulder pain?
Mostly, yes. Many clinicians now prefer the term rotator cuff related shoulder pain, because the idea that a bone is pinching the tendon does not fit the evidence well. Trials of surgery to remove bone found it worked no better than placebo surgery.
How long does rotator cuff shoulder pain take to get better?
It varies. Many people notice steady improvement within a few months of a well-planned exercise programme. Some cases take longer, especially if the shoulder keeps being overloaded.
Should I rest my shoulder completely?
Usually not. Short-term changes to heavy or overhead tasks can help, but keeping the shoulder moving and gradually rebuilding strength is the approach the evidence supports.
References
- Östör A et al. (2005). Diagnosis and relation to general health of shoulder disorders presenting to primary care. Rheumatology. View source
- Lafrance S et al. (2024). The efficacy of exercise therapy for rotator cuff related shoulder pain according to the FITT principle: a systematic review with meta-analyses. Journal of Orthopaedic & Sports Physical Therapy. View source
- Page M et al. (2016). Manual therapy and exercise for rotator cuff disease. Cochrane Database of Systematic Reviews. View source
- Karjalainen T et al. (2019). Subacromial decompression surgery for rotator cuff disease. Cochrane Database of Systematic Reviews. View source
- Beard D et al. (2018). Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial. The Lancet. View source
- Cook T et al. (2018). Are corticosteroid injections more beneficial than anaesthetic injections alone in the management of rotator cuff-related shoulder pain? A systematic review. British Journal of Sports Medicine. View source
This page is general information, not a diagnosis or a substitute for medical advice. If you are worried about your symptoms, speak to your GP or a registered healthcare professional. Content prepared from the sources above, November 2026.
