---
title: "Shoulder Pain"
---
## Shoulder Pain Has More Causes Than Most Patients Are Told
Shoulder pain is one of the most commonly mislabeled musculoskeletal complaints. Patients often arrive having been told they have shoulder arthritis when they actually have a rotator cuff issue. Or they have been told they need surgery when their problem responds well to non-surgical treatment. Or they have been treated with cortisone repeatedly without anyone identifying what is actually causing the pain.
The shoulder is a complex joint with multiple structures that can generate pain: the rotator cuff, the labrum, the bursae, the biceps tendon, the joint capsule, the AC joint, and the glenohumeral joint itself. When something goes wrong with any of these, the pain can feel broadly similar but actually has very different causes and treatments. The right treatment depends on the right diagnosis.
## Common Sources of Shoulder Pain
The pattern of your pain often points to the source.
#### Pain with overhead activities
Pain that develops or worsens with reaching, lifting, throwing, or swimming often suggests rotator cuff tendinopathy, rotator cuff tears, subacromial bursitis, or shoulder impingement. These conditions are more common than shoulder arthritis and respond well to PRP therapy, image-guided injections, and structured rehabilitation.
#### Pain at night, or stiffness with severe limitation
Night pain when lying on the shoulder often involves rotator cuff problems, arthritis, or frozen shoulder. Significant loss of range of motion, particularly the ability to rotate your arm or reach behind your back, often suggests frozen shoulder (adhesive capsulitis), which has a distinctive course over months and responds to specific treatment. See our Shoulder Arthritis page for more on cartilage wear.
#### Pain at the top of the shoulder, or catching and clicking
Pain at the top of the shoulder, particularly with cross-body movements or carrying, often suggests AC joint arthritis or injury. Sharp catching, clicking, or instability with specific movements can suggest labral tears, biceps tendon problems, or loose bodies, which often benefit from imaging-confirmed diagnosis.
#### Pain after a specific injury
Shoulder pain that developed after a fall, contact, or twisting injury often involves the structures most stressed by that mechanism. Acute injuries often need both diagnostic imaging and active treatment to support proper healing.
## When to See Someone
Consider professional evaluation when your shoulder pain has lasted more than four to six weeks without improvement, when it interferes with sleep, work, or activities, when you are avoiding overhead activities, when conservative treatments have not helped, or when you have been treated for one diagnosis without success.
Seek prompt evaluation if you experience sudden severe shoulder pain following a fall, significant new arm weakness, inability to lift the arm at all, visible deformity, significant joint swelling, warmth, or redness, or shoulder pain accompanied by chest pain or other symptoms that can indicate a cardiac cause requiring immediate evaluation.
## How PHI Approaches Shoulder Pain
The first step is comprehensive evaluation to identify the actual source: a detailed history of what makes the pain worse or better, an examination with specific tests for rotator cuff involvement, joint pathology, labral issues, and frozen shoulder, review of imaging, and sometimes a diagnostic injection when uncertainty exists.
Once the source is clear, options include image-guided shoulder injections with cortisone (the shoulder has multiple targets, so image guidance ensures the medication reaches the right structure), PRP therapy for rotator cuff tendinopathy, partial tears, and AC joint problems, stem cell therapy for moderate to severe conditions, A2M therapy for cartilage involvement, and exosome therapy within comprehensive protocols. For full-thickness rotator cuff tears requiring repair, significant labral injuries, or end-stage arthritis, we coordinate with orthopedic specialists.
## Why PHI for Shoulder Pain
## Frequently Asked Questions
**Q: How do I know if my shoulder pain is from rotator cuff or arthritis?**
The pattern often gives strong clues. Rotator cuff issues typically involve pain with overhead activities, weakness, and night pain when lying on the shoulder. Arthritis typically involves stiffness, deep aching pain, and gradual loss of range of motion. The two often coexist, and physical examination plus imaging usually identifies which is dominant.
**Q: Do I need surgery for a rotator cuff tear?**
Not necessarily. Many rotator cuff tears, particularly partial and degenerative tears in patients over 50, respond well to non-surgical treatment including PRP, image-guided injections, and structured rehabilitation. Acute traumatic tears in younger active patients are more likely to benefit from surgical repair. We help you understand which category your tear falls into.
**Q: What about frozen shoulder?**
Frozen shoulder (adhesive capsulitis) has a specific course and responds to specific treatment. Image-guided injections combined with structured physical therapy is typically the first approach, and some patients benefit from hydrodilatation. Most cases resolve over time with appropriate treatment, though the timeline can be long, months to a year or more.
**Q: I have a rotator cuff tear on imaging. Should I be worried?**
Many rotator cuff tears identified on imaging in patients over 40 are not the source of their pain and do not require treatment. Patients can have significant rotator cuff changes while remaining functional and pain-free. The relationship between imaging findings and symptoms is not always direct, and your physician can help you understand whether your specific findings are likely causing your pain.
**Q: Can PRP help my rotator cuff?**
PRP has accumulating evidence for rotator cuff tendinopathy and partial tears. For appropriate candidates, it can produce meaningful improvement in pain and function. It is most appropriate for partial tears and tendinopathy rather than full-thickness tears in active patients. Your physician will discuss whether PRP fits your situation.
**Q: I've had multiple cortisone shots in my shoulder. Is that a problem?**
Repeated cortisone in the same shoulder location has cumulative considerations. For most patients occasional cortisone is appropriate. For patients requiring frequent repeat injections, regenerative options often make more sense both for the underlying tissue and for managing symptoms.
**Q: Do you take insurance?**
Insurance coverage and payment options may vary. All pricing is disclosed at consultation.
**Q: How quickly can I be seen?**
Contact our concierge team and we'll coordinate your consultation and plan of care. Call (310) 856-9488 to discuss timing.
**Q: Do you accept international patients?**
Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations.
## Treatments We Offer for Shoulder Pain
PHI offers the full range of evidence-based treatments for shoulder pain. Your physician will recommend the right option, or combination, based on the actual source of your pain, your imaging, and your treatment history.
- Shoulder Injections, image-guided
- PRP Therapy, strong evidence for rotator cuff tendinopathy
- Stem Cell Therapy
- A2M Therapy
- Exosome Therapy
> Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study. Peer-reviewed via PubMed.
— [Kuhn JE, et al.](https://pubmed.ncbi.nlm.nih.gov/23540577/)
> Clinical practice guideline: management of rotator cuff injuries. American Academy of Orthopaedic Surgeons.
— [American Academy of Orthopaedic Surgeons](https://www.aaos.org/quality/quality-programs/upper-extremity-programs/rotator-cuff-injuries/)
## Schedule Your Shoulder Pain Consultation
A 60-minute consultation will identify the actual source of your shoulder pain, walk through the treatment options that match it, and give you a clear plan. Call (310) 856-9488 or book online now.
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