Shoulder pain is one of the most frequent musculoskeletal complaints. Determining the appropriate healthcare provider to consult first can be confusing, especially since the shoulder is a complex joint with many potential sources of pain. This guide clarifies the pathway to care, allowing you to seek the right medical attention based on the severity and duration of your symptoms. Following a logical progression of care leads to a more accurate diagnosis and a faster return to normal function.
Situations Requiring Immediate Medical Attention
Sudden, intense shoulder pain following a traumatic event, such as a fall or accident, requires immediate medical evaluation. Seek emergency care if you experience a visible deformity, the arm appears “out of place,” or you have an inability to move the arm at all. These symptoms may indicate a fracture, a complete tendon rupture, or a joint dislocation, which need prompt stabilization and reduction.
Shoulder pain can also signal a more serious, non-musculoskeletal condition requiring urgent assessment. Seek emergency medical care if the pain is accompanied by chest pressure, shortness of breath, dizziness, or if the pain radiates from the chest to the left arm, neck, or jaw, as these symptoms can indicate a cardiac event. Other red flags include sudden, severe swelling, redness, or warmth around the joint, particularly if accompanied by a fever, which may suggest an infection like septic arthritis.
The Role of Primary Care Physicians
For shoulder pain not resulting from severe trauma and lacking red flag symptoms, the standard first step is a visit to a Primary Care Physician (PCP) or General Practitioner (GP). The PCP serves as the initial diagnostic filter for non-urgent, mild-to-moderate discomfort. They assess the general nature of the pain, taking a thorough medical history to determine if the cause is musculoskeletal or referred pain from the neck, lungs, or abdomen.
The PCP initiates conservative management, prescribing anti-inflammatory medications and recommending initial rest or activity modification. They perform basic physical examination maneuvers to identify common issues like tendonitis, bursitis, or mild rotator cuff strain. If the pain is non-responsive after a trial of two to four weeks, the PCP acts as the gateway to specialized care. At this point, they can order initial diagnostic imaging, such as X-rays, and provide a referral to a specialist if the condition warrants advanced treatment or a more detailed diagnosis.
Direct Access to Conservative Care Providers
For many types of shoulder pain, especially those related to overuse, chronic stiffness, or minor strains, you may be able to bypass the PCP referral and directly access conservative care providers, depending on insurance and local regulations. Physical Therapists (PTs) specialize in movement and rehabilitation, making them an excellent choice for mechanical shoulder issues. They assess the biomechanics of the shoulder, spine, and surrounding muscles to identify movement patterns contributing to pain, such as impingement or instability.
A PT’s treatment plan focuses on non-surgical methods. This includes therapeutic exercises to restore strength to the rotator cuff and periscapular muscles, improving range of motion through mobilization techniques, and patient education on proper posture and lifting mechanics. Early access to physical therapy has been shown to help prevent the condition from becoming chronic.
Sports Medicine Physicians also specialize in non-operative musculoskeletal care and are skilled at diagnosing and managing shoulder injuries resulting from physical activity, such as rotator cuff tears and tendinitis. They can use tools like ultrasound-guided injections for pain relief and often work closely with PTs to coordinate a rehabilitation plan, addressing both the immediate pain and the underlying functional deficit.
When to Consult an Orthopedic Specialist
Consultation with an Orthopedic Specialist becomes necessary when conservative treatments fail to provide adequate relief over several weeks to months, or when initial imaging points to significant structural damage. This includes cases where pain persists beyond four weeks, progresses in severity, or severely limits daily activities and sleep. Orthopedic specialists are the experts for conditions requiring advanced intervention.
Referral is indicated for confirmed structural problems like large or full-thickness rotator cuff tears, advanced arthritis, complex labral tears, or recurring joint instability following multiple dislocations. The specialist provides a diagnosis using advanced imaging like Magnetic Resonance Imaging (MRI) and discusses options ranging from specialized injections, such as corticosteroid or regenerative therapies, to surgical repair. A Rheumatologist may also be consulted if the shoulder pain is suspected to be part of a systemic inflammatory condition, such as rheumatoid arthritis, characterized by pain in multiple joints, warmth, and swelling.