Common in later life, and often not mentionedStrong evidence
About 1 in 5 people over 70 had a shoulder problem in a UK community survey (21% of 644 people; 25% of women and 17% of men), about 70% of them involving the rotator cuff, and fewer than 40% had asked for medical help. About 3% to 4% of people aged 65 and over see a GP about a shoulder each year: in 12 English practices in 2006, 366 men and 398 women in every 10,000 aged 65 to 74 consulted about a shoulder, and 280 men and 343 women aged 75 and over. Across all adults, 2.36% consult each year, a rate that rises through adult life.
Figures vary with how pain is counted: across 18 studies, 6.9% to 26% of people had shoulder pain at the time they were asked and 4.7% to 46.7% at some point in a year, and in a Greater Manchester survey, 16% of adults had shoulder pain lasting more than a week in the past month. In 7,878 adults aged 50 and over in North Staffordshire, pain that got in the way of daily activities became more common with age, even though pain in most parts of the body other than the legs became less common in the oldest groups. In a US community study (average age 68), shoulder symptoms went with other health conditions, low mood and worse function, and lying on the sore side, dressing and reaching are the usual struggles, NHS inform says.
Sources 1, 2, 3, 4, 5, 6, 7, 8, 9
The rotator cuff comes first, and torn cuffs often don't hurtStrong evidence
The rotator cuff is the group of muscles and tendons that holds the top of the arm bone in its socket and lifts and turns the arm. It was involved in about 70% of shoulder problems in people over 70 in the UK survey, and the British Elbow and Shoulder Society's care pathway puts rotator cuff pain at up to 70% of all shoulder pain. It usually hurts at the top and outside of the shoulder and upper arm, worse lifting the arm out or overhead, reaching behind you (into a jacket sleeve) or lying on that side, often with a painful arc partway up. Movement hurts but isn't blocked: someone else can lift your arm higher than you can. It is often called impingement, though Arthritis UK says it comes from overuse or age-related changes in the tendons themselves, not from the tendons being trapped by bone, as was once thought. "As you get older, normal age-related changes can cause your shoulder problem to flare-up now and again, often for no reason," NHS inform says: a reason to keep the shoulder moving and strong, not a sign it is wearing out.
Tears in the rotator cuff become common with age, often without symptoms. In a Japanese village screened by ultrasound (664 people), full-thickness tears were found in 10.7% of people in their 50s, 15.2% in their 60s, 26.5% in their 70s and 36.6% in their 80s, and 65.3% of the tears caused no symptoms: half of those in people in their 50s, and two-thirds over 60. Among 411 German volunteers with no shoulder symptoms, 13%, 20%, 31% and 51% of those in their 50s, 60s, 70s and over 80 had a tear, and 7.6% of 420 Norwegians aged 50 to 79 without symptoms had a full-thickness tear. Across 30 studies (6,112 shoulders), rotator cuff changes rose from 9.7% at 20 and under to 62% at 80 and over, about as often in shoulders without symptoms as with them, which the authors describe as a common part of normal ageing. The exact rates depend on the scan and how a tear is defined.
A tear that doesn't hurt costs little: in one study, shoulders with a painless tear worked only slightly less well than shoulders with an intact cuff, a difference too small to matter. Tears that do cause trouble bring weakness: in a Japanese village study of 683 people, shoulders with a tear were weaker lifting the arm out to the side and turning it outwards. So a tear on a scan isn't proof that it is causing your pain.
Some painless tears start to hurt or grow over a few years, in small, selected groups followed over time: 23 of 45 (51%) became painful over an average of 2.8 years in people with a painful tear in the other shoulder; 44 of 195 people developed pain during yearly checks, and when pain started, 18% of full-thickness tears had grown by more than 5 millimetres; and 18 of 50 painless tears began to hurt over 3 years, and those had grown more (10.6 against 3.3 millimetres on average).
Sources 1, 10, 8, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22
After a fall: a broken shoulder, a dislocation or a torn cuffStrong evidence
Breaks at the top of the arm bone (proximal humerus fractures) are the third commonest fracture from thin bones, after the wrist and the hip. In a Finnish town there were 82 a year for every 100,000 adults (114 in women and 47 in men; 73% were in women), rising with age and peaking in winter, and 78% were treated with a sling. In 1,027 breaks in Edinburgh, most were in older people the authors described as fit, and the rate was highest in women aged 80 to 89. The signs are severe pain, swelling and bruising that can spread down the arm, and not being able to lift it; a numb or tingling arm or hand, or an arm that has changed colour or shape, needs 999 or A&E, the NHS says.
A dislocation brings its own injuries. After one, about 40% of people over 40 have a torn rotator cuff (41% at 40 to 55, 71% at 56 to 70 and 100% over 70 in one study), and about 13.5% have a nerve injury; in 3,633 dislocations (average age 47.6), a third (33.4%) came with a cuff tear or a break of the bony point at the top of the arm bone. A tear caused by an injury needs urgent referral and should ideally be seen at the next available specialist clinic, the UK care pathway says, so sudden weakness lifting the arm after a fall needs a same-day check.
Thin bones make a break from a simple fall more likely. "If you're over 50 and have broken your arm or wrist, a fracture liaison service can help you prevent further broken bones," the NHS says, and the UK osteoporosis guideline asks for anyone with a fracture from thin bones to be checked for an underlying cause (a strong recommendation).
Sources 23, 24, 25, 26, 27, 28, 29, 10, 30
Stiff shoulders: frozen shoulder and arthritisMixed evidence
Frozen shoulder brings a deep ache and stiffness in every direction, especially turning the arm outwards, often worse at night. About 2.4 in every 1,000 people develop it each year and 2% to 5% are affected at some point, typically women aged 45 to 60, with a peak at 56, the 2025 UK frozen shoulder pathway says; in 2,190 people treated for it at a US hospital, the average age was 56.4. People with diabetes are about 5 times as likely to have it, a review of 18 studies found: 13.4% of people with diabetes have it, and 30% of people with frozen shoulder have diabetes. No study gives a rate after 70. The 2015 UK pathway asks for normal X-rays before frozen shoulder is diagnosed, to rule out arthritis, which looks similar; the 2025 update adds that in people over 40, a tumour can rarely be mistaken for frozen shoulder.
Arthritis of the shoulder joint (osteoarthritis) builds up over years, with an ache, stiffness, a grating or crackling feeling and a big loss of turning the arm outwards. On X-ray it was found in 17.4% of 541 Japanese villagers aged 40 and over (20.3% at 65 and over, more with age), in 16.1% of 679 Koreans aged 65 and over (mostly mild) and in 5% of 696 Koreans aged 65 and over graded more strictly, so the figures depend on the definition. It causes 2% to 5% of new shoulder pain in people over 45 seen by a GP, and the X-ray changes match symptoms only weakly.
The joint at the end of the collarbone, the acromioclavicular (AC) joint, changes with age too: arthritis changes were found in 48% of 953 shoulders examined after death and 70% of 210 magnetic resonance imaging (MRI) scans of shoulders without symptoms, more often with age, so a review says the diagnosis "should be made sparingly".
Sources 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 12, 42
Polymyalgia rheumatica: both shoulders, stiff for hours each morningStrong evidence
Polymyalgia rheumatica causes pain, stiffness and inflammation in the muscles around the shoulders, neck and hips, and its main symptom is morning stiffness that lasts longer than 45 minutes. Most people diagnosed are over 65, it's very rare under 50 and it's more common in women, the NHS says. In 125 people with new polymyalgia rheumatica (average age 71.5), 99% had aching in both shoulders, and morning stiffness lasted a median of 2 hours, against 10 minutes in 52 people with other shoulder problems: the long morning stiffness is the clue.
In the UK, about 96 in every 100,000 people over 40 are diagnosed with it each year, and the lifetime risk was about 2.4% for women and 1.7% for men in a US population. Symptoms "typically respond dramatically" to steroid tablets, the British Society for Rheumatology's 2026 guideline says, and treatment usually lasts 12 months to 2 years (a median of 15.8 months of continuous treatment in UK records). The guideline asks for muscle strengthening and a review of fracture risk, including falls, to start soon after diagnosis, while noting that the evidence for exercise in polymyalgia rheumatica itself is lacking.
Other problems can look like it: shoulder arthritis, frozen shoulder and rotator cuff problems can, and so can calcium crystals, found on ultrasound in 25 of 52 people thought to have polymyalgia rheumatica in a French clinic. Up to 1 in 5 people with polymyalgia rheumatica develop temporal arteritis (giant cell arteritis), the NHS says, while the guideline gives 5% to 10%. Either way, a new headache, scalp tenderness, jaw pain when eating or a change in your sight needs a GP or NHS 111 immediately, and suddenly losing sight in 1 or both eyes needs 999 (the warning signs).
Sources 43, 44, 45, 46, 47, 48, 49, 50
Could it be the heart?Strong evidence
Rarely, shoulder pain comes from the heart. The NHS heart attack page's 999 signs include chest pain that feels tight or like squeezing, and chest pain spreading to your arms, neck or jaw; it doesn't name the shoulder, which is why our warning line ties shoulder or arm pain to chest pain. The NHS angina page does name the shoulders: angina's main symptom is sudden pain in your chest, neck, shoulders, jaw or arms, often brought on by exercise, stress, emotion or cold and easing with rest. Get help from NHS 111 if it comes and goes; the angina page's 999 signs include chest pain that doesn't go away, and pain that spreads to your arm, neck, jaw, shoulder, stomach or back.
In reviews of studies of people seeking care for chest pain, pain that spread to one or both shoulders or arms, or came on with effort, raised the odds of a heart cause 2.3 to 4.7 times, and chest pain spreading to both arms at once raised the odds of a heart attack 7.1 times. These studies were of chest pain, not shoulder pain on its own, and most shoulder pain in later life comes from the shoulder itself.
Sources 51, 52, 53, 54, 1
The lung, an infection, myeloma, a stroke and the neckEmerging evidence
A tumour at the top of the lung (a Pancoast tumour) is rare: 3% to 5% of lung cancers, linked mainly with smoking. Shoulder pain is its most common early symptom, often with pain down the arm, a weak hand or a drooping eyelid, and it is hard to see on a plain chest X-ray; computed tomography (CT) and MRI scans show it better. One case report describes 6 months of treatment for a rotator cuff problem before it was found. The NHS lists chest or shoulder pain among the symptoms of lung cancer, but the National Institute for Health and Care Excellence (NICE) criteria for a chest X-ray or referral from 40 (a cough, tiredness, breathlessness, chest pain, weight loss or loss of appetite, or coughing up blood) don't mention the shoulder. The clue is constant pain that doesn't change with position, in someone who smokes or used to, especially with a cough or weight loss. These figures come from one review and a case report.
A joint infection brings sudden severe pain, difficulty moving the joint, hot, swollen or red skin and usually a high temperature, although not everyone has one. It is rare but much more common in later life: in UK hospitals, infections of natural joints rose from 5.5 to 7.8 per 100,000 people a year between 1998 and 2013, and from 15 to 31 per 100,000 a year in people over 75. Myeloma, a cancer of the bone marrow, can cause bone pain in the back, hips, shoulders or ribs, with tiredness, thirst and weight loss, and NICE asks GPs to offer blood tests to people aged 60 and over with persistent bone pain or an unexplained fracture.
After a stroke, shoulder pain on the weak side is common: 29% of stroke survivors had it within a year in an Australian population study, peaking at 4 months, and 10% to 22% developed it across 18 studies; the stroke team can help. A sudden weak arm, especially with a drooping face or slurred speech, is a 999 call. Pain from the neck is common too, though no study gives a figure for older adults: tingling in the hand or arm with the shoulder pain is likely to come from the neck, Arthritis UK says, and NHS inform says you may feel pains around your shoulder and neck, and into your arm.
Sources 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 12, 13
When a scan or test helpsStrong evidence
Usually not at first. The NHS and NHS inform start with 2 to 6 weeks of looking after it at home, and the UK care pathway says an ultrasound or MRI scan of the rotator cuff "is rarely indicated in primary care" and that a tear on a scan "does not always correlate with symptoms". Scans find tears in many shoulders that don't hurt (above).
A scan changes what happens in some cases: an X-ray after a fall, for a break or a dislocation; X-rays when shoulder pain isn't improving with treatment, and before diagnosing frozen shoulder, to rule out arthritis; an ultrasound or MRI scan promptly for sudden weakness after an injury, and after a dislocation in anyone over 40, because a tear from an injury does best with early specialist review; and scans of the cuff in specialist care when surgery is being considered. Blood tests for inflammation help when polymyalgia rheumatica is suspected, and NICE's blood tests for myeloma are for people aged 60 and over with persistent bone pain. A tumour at the top of the lung can hide behind the collarbone on a plain chest X-ray, and CT shows it better. A suspected joint infection needs tests in hospital.
Sources 65, 13, 10, 17, 25, 27, 35, 28, 47, 58, 55, 59
How it usually goesEmerging evidence
"You usually need to do these things for 2 weeks before shoulder pain starts to ease. It can take 6 months or longer to recover from shoulder pain," the NHS says, and NHS inform says that in many cases a new pain or a flare should begin to settle within 6 weeks. In the GRASP trial of rotator cuff pain (708 adults), every group improved substantially over a year, and in a study of 452 people with tears that came on without an injury, physiotherapy worked for about 75% at 2 years.
Frozen shoulder takes months to years. In 223 people followed for an average of 4.4 years, 59% had normal or near-normal shoulders and 41% still had some symptoms, 94% of them mild, and a review found no evidence that it passes through set phases to a full recovery on its own. NHS inform says most people improve, but it can take more than 2 years, and longer with diabetes or thyroid problems.
After a broken shoulder, the sling or collar and cuff usually stays on for about 6 to 12 weeks, and most of the recovery comes in the first 6 weeks, an NHS trust says; movement can take 3 months or longer to come back, and strength up to a year. The bone's first healing takes about 3 to 6 weeks, another trust says. Polymyalgia rheumatica usually needs steroids for 12 months to 2 years. No one can promise a timescale.
Sources 65, 13, 66, 67, 68, 69, 9, 26, 70, 43, 45
