Orthopaedic Health Series

Beyond A Shoulder Shrug

From Frozen Shoulder to Rotator Cuff Tears: When a Simple Ache is Harmless and When it is Time to Seek Medical Attention

by Dr Poh Keng Soon – Orthopaedic and Hand Surgery Partners

Woman holding her painful shoulder, with an anatomical overlay highlighting the shoulder joint and surrounding muscles.

Understanding shoulder pain begins with identifying its cause—from frozen shoulder to rotator cuff problems.

Our shoulders are among the hardest-working joints in our bodies. We rely on them to reach for a coffee mug, lift a toddler or serve a tennis ball. Often, we hardly notice how much they do—until pain makes these movements difficult.

Shoulder pain is one of the most common musculoskeletal problems seen in medical practice. It affects Singaporeans of all ages. While some aches settle with rest, others signal an underlying condition that requires treatment. Knowing the difference can help prevent long-term disability.

It often starts innocently enough. A young professional reaches for a laptop bag after a long day at work and feels a sharp twinge in the shoulder. A parent struggles to lift a toddler into a car seat. An avid golfer notices a loss of power and accuracy in their swing. Meanwhile, some active retirees find themselves woken up repeatedly through the night because simply rolling onto one shoulder causes considerable pain.

Yet, many people simply shrug shoulder pain off. They tell themselves: “It’s just a muscle strain,” “I’m getting older” or “It’ll go away.” While this is sometimes true, persistent or worsening shoulder pain may be your body’s way of telling you that something more significant is happening.

Fortunately, most shoulder conditions respond well to treatment, particularly when recognised early. Delaying medical attention, however, may cause the problem to worsen, leading to a longer recovery period or in some cases, more complex treatment. Understanding the common causes of shoulder pain and recognising when to seek help can make all the difference.

WHY IS THE SHOULDER SO VULNERABLE?

The shoulder is one of the most remarkable joints in the human body. Unlike the hip, which is designed primarily for stability, the shoulder is built for mobility. In fact, it has the greatest range of movement of any joint in the body.

It allows us to reach overhead, throw a ball, swim, hug our loved ones, lift luggage into an overhead compartment and perform countless everyday activities with ease. However, this extraordinary freedom comes at a price.

Rather than relying on a deep, stable socket like the hip, the shoulder depends on a finely balanced network of muscles, tendons, ligaments and cartilage to keep the ball of the upper arm (the humeral head) centred within a relatively shallow socket (the glenoid).

Because so many structures must work together in perfect harmony, even a small injury or gradual wear and tear can upset this delicate balance, resulting in pain, weakness, stiffness, instability or loss of function.

Common shoulder conditions include frozen shoulder, rotator cuff disease and tears, shoulder instability (recurrent dislocations), shoulder impingement, tendinitis and shoulder arthritis. It is therefore no surprise that shoulder pain is one of the most common reasons people seek orthopaedic care. The encouraging news is that most shoulder conditions can be treated successfully, particularly when recognised early and managed appropriately

NOT JUST AN AGEING PROBLEM

One of the most common things I hear in my clinic is, “Doctor, I suppose it’s just old age.” While age certainly influences the types of shoulder problems we develop, shoulder pain is by no means exclusive to older adults. In reality, shoulder conditions can occur at any age, and I regularly treat patients ranging from teenagers to active older adults. Young athletes may sustain

shoulder dislocations during contact sports, while office workers often develop shoulder pain after years of poor posture and prolonged computer use. Gym enthusiasts sometimes injure their rotator cuff while lifting weights, whilst golfers and tennis players frequently develop overuse injuries from repetitive overhead movements.

Older adults are more likely to develop rotator cuff degeneration or tears, frozen shoulder, or shoulder arthritis as part of the natural ageing process. However, these conditions are not inevitable, nor should they simply be accepted as part of “getting older.” Regardless of age, the symptoms are often remarkably similar.

Common warning signs include:

Pain when reaching overhead or behind your back.
Difficulty fastening a bra, putting on a jacket or reaching for objects on a high shelf.
Weakness when lifting or carrying everyday items.
Shoulder pain that disrupts your sleep, especially when lying on the affected side.
Gradually losing the ability to move the shoulder, making simple daily activities increasingly difficult.

Persistent shoulder pain or loss of function deserves proper assessment. Identifying the underlying cause early often allows simpler treatment and a quicker return to normal activities.

BEYOND THE SHOULDER

One fact that surprises many patients is that not all shoulder pain actually originates from the shoulder itself. The nerves supplying the shoulder arise from the neck, so conditions such as a trapped nerve or cervical disc problem may produce pain that feels as though it is coming from the shoulder. Less commonly, disorders involving the heart, lungs or even the diaphragm can also present as shoulder pain through a phenomenon known as referred pain. This is why a careful medical assessment is so important. Treating the wrong problem not only delays recovery but may also allow a more serious underlying condition to go unrecognised.

WHEN SHOULD YOU SEE A DOCTOR?

While mild shoulder strains often settle within a few days, certain symptoms should prompt medical attention. You should seek professional assessment if you experience:

Shoulder pain lasting more than two to three weeks.
Significant weakness when lifting the arm.
Inability to raise the arm after an injury.
Pain that consistently wakes you at night.
Recurrent shoulder dislocations.
Visible deformity following trauma.
Fever, redness or swelling around the shoulder.
Persistent numbness or tingling extending into the arm.

These symptoms do not always indicate a serious condition, but they warrant proper evaluation to determine the cause and ensure that appropriate treatment is started before the problem progresses.

A PERSONALISED APPROACH MAKES THE DIFFERENCE

No two patients are the same, and neither are their shoulders. A successful treatment plan begins not only with making the correct diagnosis but also with understanding each individual’s lifestyle, occupation, sporting activities and personal goals.

Treatment starts by identifying the exact cause of the pain. Fortunately, many shoulder conditions can be managed successfully without surgery. Treatment may involve a combination of activity modification, medication and a structured physiotherapy programme. Others may benefit from image-guided injections to reduce inflammation and facilitate rehabilitation.

When structural problems such as significant rotator cuff tears, recurrent shoulder instability or advanced arthritis are present, surgery may offer the best chance of restoring function. Fortunately, advances in shoulder surgery over the past two decades, including minimally invasive arthroscopic techniques and computer-assisted planning with patient- specific 3D-printed surgical guides for shoulder replacement, have made surgery safer, less painful and more effective than ever before.

The goal of modern shoulder care extends beyond simply relieving pain. It is about restoring movement, rebuilding strength, improving quality of life, and helping patients return safely and confidently to the activities that matter most to them.

CAN SHOULDER PROBLEMS BE PREVENTED?

Although ageing is a natural part of life and not every shoulder injury can be prevented, adopting a few healthy habits can go a long way towards keeping your shoulders strong and reducing the risk of injury. Good posture and proper technique remain among the simplest yet most effective preventive measures, particularly for people who spend long hours at a computer, or those who regularly play sports or exercise. Regular strengthening of the rotator cuff and shoulder blade (scapular) muscles improves shoulder stability and reduces unnecessary strain on the tendons. It is equally important to warm up properly before sports or gym sessions, and to increase training intensity gradually, rather than attempting to heavy lift after weeks of inactivity. Perhaps the most important advice is also the simplest: listen to your body.

Pain is not something to be ignored. It is your body’s way of signalling that something may be wrong. While temporary muscle soreness after exercise is perfectly normal, persistent shoulder pain, increasing weakness, loss of movement, or pain that interferes with sleep should never be accepted as a normal part of ageing.

Our shoulders allow us to remain independent, stay active and enjoy the moments that matter most – from lifting a grandchild and carrying groceries to serving a tennis ball or swinging a golf club. Looking after them is an investment in maintaining an active and fulfilling life. If your shoulder pain persists, do not simply learn to live with it. The earlier the problem is identified, the more treatment options are available and the sooner you can return to doing the things you love. PRIME

Author

Dr. Poh Keng Soon

Senior Orthopaedic Surgeon, Orthopaedic and Hand Surgery Partners

Dr Poh specialises in diagnosing and treating conditions affecting the shoulder and elbow. These include common sports injuries as well as more complex degenerative disorders. For example, he manages rotator cuff tears, shoulder instability, recurrent shoulder dislocations, frozen shoulder, tendon injuries, arthritis and fractures involving the shoulder and elbow.

His approach focuses on selecting the most appropriate treatment for each patient. Whenever possible, he recommends non-surgical treatment before considering surgery. However, when an operation is needed, he performs arthroscopic (keyhole) procedures and advanced shoulder replacement surgery where appropriate. The aim is to restore movement, relieve pain and help patients return to the activities they enjoy.

Before entering private practice, Dr Poh served as a Consultant in the Department of Orthopaedic Surgery at the National University Hospital and Alexandra Hospital. In addition, he continues to contribute to public healthcare as a Visiting Consultant at the National University Hospital. He also remains actively involved in the education and training of future orthopaedic surgeons.

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