Why won’t my shoulder pain heal and what should I do about it?
Summary
Shoulder pain that lingers longer than six weeks usually means there is more than a simple strain—most often a rotator-cuff tendon tear, frozen shoulder, impingement, or referred pain from the neck. Ongoing pain, night discomfort, weakness, or loss of range of motion are signals to see a clinician for imaging and a structured rehab plan. Early evaluation prevents irreversible stiffness and reduces the chance you will need surgery.
Why does shoulder pain that lasts more than six weeks usually signal true tissue damage?
A shoulder that still aches after the normal three-to-six-week healing window often involves structural injury, not just muscle soreness. Recognizing this helps you decide when to escalate care.
- Rotator-cuff fibres heal slowlyThe supraspinatus tendon has limited blood flow; partial tears commonly stay painful for 3-12 months without guided therapy.
- Frozen shoulder literally locks the capsuleAdhesive capsulitis causes the joint lining to contract by up to 40 % in MRI studies, explaining why pain persists and motion shrinks.
- Neck arthritis can masquerade as shoulder painUp to 30 % of chronic "shoulder" cases originate from C5-C6 foraminal stenosis, so treating only the shoulder misses the source.
- Diabetes doubles risk of prolonged painHigh glucose stiffens collagen, making diabetics twice as likely to develop frozen shoulder, according to a 2021 meta-analysis.
- Expert insight“When pain refuses to settle after six weeks, we assume a mechanical problem until proven otherwise,” says Sina Hartung, MMSC-BMI.
- Lingering pain usually signals structural injuryAlpha Orthopedics notes that shoulder discomfort persisting beyond six weeks is frequently traced to tangible problems such as rotator-cuff or labral tears, fractures, or impingement, making prompt orthopedic evaluation essential. (AlphaOrtho)
- Six-week milestone marks need for medical reviewUniversity of Michigan Health warns that when shoulder pain lasts longer than about six weeks, it may indicate a serious underlying condition rather than a simple strain and should trigger medical assessment to avoid ongoing tissue damage. (UofMHealth)
References
- UofMHealth: https://www.uofmhealth.org/health-library/shoul
- AlphaOrtho: https://www.alphaortho.net/blog/when-does-your-shoulder-pain-need-medical-attention
- HSS: https://www.hss.edu/health-library/conditions-and-treatments/list/shoulder-pain-causes
- BVHealth: https://www.blackwoodvillagehealth.com.au/why-shoulders-take-so-long-to-heal/
- Samitivej: https://www.samitivejhospitals.com/article/detail/the-dangers-of-chronic-shoulder-pain
Which symptoms mean you should seek same-day medical review?
Some red-flag features point to serious injury or systemic illness and should never be watched at home.
- Sudden inability to lift the armAn acute rotator-cuff rupture leaves the arm hanging; prompt ultrasound within 72 hours optimises surgical outcomes.
- Night pain that wakes youConstant nocturnal pain can indicate bone infection or metastatic disease—both require urgent imaging.
- Shoulder pain with chest pressureUp to 7 % of heart attacks present primarily as shoulder discomfort; call emergency services if pain is crushing or accompanied by shortness of breath.
- Numb hand or fingersProgressive sensory loss suggests nerve compression or brachial plexus injury, warranting same-week neurologic review.
- Expert insight“Sharp pain with any red-flag sign buys you an immediate slot, not a wait-and-see approach,” warns the team at Eureka Health.
What diagnoses account for 90 % of stubborn shoulder pain?
Knowing the common culprits helps you and your clinician focus diagnostic tests efficiently.
- Partial-thickness rotator-cuff tearResponsible for roughly 45 % of chronic cases in people over 40; MRI shows fraying but not complete rupture.
- Subacromial impingementRepeated overhead work narrows the subacromial space to under 6 mm on dynamic ultrasound, irritating the bursa.
- Adhesive capsulitis (frozen shoulder)Characterised by loss of external rotation first; stage 1 pain often precedes measurable stiffness by six weeks.
- Glenoid labrum tearCommon in throwers; 40 % show a positive O’Brien test indicating a SLAP lesion requiring different rehab than cuff tears.
- Expert insight“Labeling the pain correctly is half the treatment plan,” notes Sina Hartung, MMSC-BMI.
- Spine-related referral mimics true shoulder disordersStudies show cervical or thoracic spine problems account for roughly 40 % of pain that patients (and even clinicians) first attribute to the shoulder, so lingering symptoms often resolve only after the neck or mid-back is addressed. (MMSSPT)
References
- NCBI: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4935112/
- Harvard: https://www.health.harvard.edu/pain/what-to-do-about-rotator-cuff-tendinitis
- Healthline: https://www.healthline.com/diabetesmine/frozen-shoulder
- MMSSPT: https://www.mmsspt.com/the-number-one-reason-your-shoulder-pain-is-not-going-away/
Which self-care steps speed recovery in most non-surgical cases?
Evidence-based home strategies can cut recovery time by several weeks when started early.
- Pendulum swings twice dailyGentle traction reduces capsular stiffness; studies show a 20 % gain in forward flexion within four weeks.
- Isometric cuff strengtheningPressing the forearm into a doorway for 5-second holds activates the infraspinatus without provoking pain.
- Heat before, ice after exerciseApplying moist heat for 10 minutes increases tendon elasticity, while post-exercise ice curbs inflammatory cytokines.
- Ergonomic changes at workLowering the keyboard so elbows rest at 90° cuts upper-trapezius load by one-third, according to EMG data.
- Expert insight“Consistency beats intensity; five minutes daily outperforms a weekend workout binge,” advises the team at Eureka Health.
- Gentle daily range-of-motion shortens stiffnessNHS guidance recommends starting light shoulder movements and gradually increasing activity; most uncomplicated cases improve within about six weeks when movement is maintained. (NHS)
- Short NSAID courses enable earlier rehabCombining temporary activity modification with over-the-counter NSAIDs or acetaminophen reduces pain enough to continue therapeutic exercise, a cornerstone of non-operative recovery. (SSNYC)
References
- NHS: https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/arm-shoulder-and-hand-problems-and-conditions/shoulder-problems/
- SSNYC: https://www.shouldersurgerynyc.com/conditions-treatment-principles-of-non-operative-treatment
- Harvard: https://www.health.harvard.edu/pain/ouch-shoulder-pain-and-how-to-treat-it
- Healthline: https://www.healthline.com/health/shoulder-pain-remedies
What imaging, labs, and treatments do doctors consider when pain won’t settle?
If home care stalls, targeted tests and interventions clarify the cause and open new treatment options.
- High-resolution ultrasound firstIdentifies 92 % of full-thickness cuff tears and is cheaper and faster than MRI.
- MRI with contrast for labral doubtsMR arthrogram offers 93 % sensitivity for SLAP lesions when rotator cuff appears intact.
- Inflammatory markers for suspected infectionESR above 40 mm/hr plus a white-cell count over 12 000 strongly predicts septic arthritis.
- Image-guided corticosteroid injectionDelivers medication within 2 mm of the inflamed bursa, providing 50 % pain relief at six weeks in controlled trials; a clinician must weigh risks such as tendon weakening.
- Expert insight“Choosing the right study prevents guess-and-check treatments,” says Sina Hartung, MMSC-BMI.
- Plain radiographs still the gateway testACR guidelines label a standard two-view shoulder X-ray as “usually appropriate” for chronic atraumatic pain, screening for fractures, arthritis, and calcific tendinopathy before costlier studies are ordered. (ACR)
- MRI considered when pain persists beyond six weeksPatient-facing recommendations highlight that clinicians typically move to MRI once pain lasts six weeks or more despite therapy, or when night pain, weakness, or instability suggest occult soft-tissue injury. (AHI)
How can Eureka’s AI doctor guide you through testing and recovery?
Digital tools now triage symptoms, suggest evidence-based next steps, and even prepare questions for your in-person visit.
- Symptom triage within 90 secondsEnter location, duration, and severity; the AI flags red-flag patterns and tells you whether to head to urgent care.
- Personalised exercise libraryEureka proposes rotator-cuff and scapular stabiliser routines based on your pain triggers and available equipment.
- Smart reminders improve adherencePush notifications increased home-exercise completion from 45 % to 78 % in an internal user review.
- Clinician-reviewed test requestsIf the AI recommends ultrasound, a licensed doctor from Eureka reviews and, when appropriate, orders it directly.
- Expert insight“We designed the system to fill the gap between ‘wait it out’ and a specialist visit,” explains the team at Eureka Health.
Why do users rate Eureka a trustworthy place to track shoulder recovery?
Beyond triage, the platform stores your progress securely and keeps your care team informed.
- Data privacy at medical-grade standardsInformation is encrypted end-to-end and never sold to advertisers.
- Continuous outcome trackingWeekly pain and range-of-motion scores plot automatically so you and your clinician see trends, not snapshots.
- High user satisfactionPeople using Eureka for musculoskeletal injuries give the app 4.7 out of 5 stars in post-visit surveys.
- Free to startCore symptom logging and basic exercise plans cost nothing, lowering the barrier to early care.
- Expert insight“Good medicine starts with good data, and patients own theirs here,” says Sina Hartung, MMSC-BMI.
Become your own doctor
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Frequently Asked Questions
How long is too long for shoulder pain to last?
If pain is still limiting normal activity after six weeks of rest and basic exercises, schedule a medical evaluation.
Can I keep lifting weights with a small rotator-cuff tear?
Light, pain-free strengthening under 5 lb is usually allowed, but overhead presses and bench press should stop until cleared.
Will an X-ray show a tendon tear?
No—X-rays only display bone. Tendon or labral injuries need ultrasound or MRI.
Is shoulder pain ever related to gallbladder disease?
Yes—gallstones can refer pain to the right shoulder tip, especially after fatty meals.
Do I need contrast dye for my shoulder MRI?
Contrast is only required if a labral tear is suspected; for cuff tears, a standard MRI suffices.
Are steroid injections safe for diabetics?
They can raise blood glucose for up to one week, so discuss tight sugar monitoring with your clinician first.
How much movement is safe during a frozen shoulder flare?
Move to the edge of discomfort, not through it; forcing motion can worsen capsular inflammation.
Can poor posture alone cause chronic shoulder pain?
Yes—rounded shoulders shorten the pectoralis minor and overload the rotator cuff, but posture correction often reduces pain within four weeks.
What supplements help tendon healing?
Evidence is mixed; collagen peptides may aid recovery, but discuss dosing and possible interactions with a healthcare provider.