Why Doesn't My Shoulder Get Better?

Shoulder pain is one of the most common musculoskeletal problems, but it's also one of the most misunderstood.

Many people assume it will settle with time, rest or physiotherapy. Sometimes it does. 

But when shoulder pain persists for months, or treatment doesn't seem to be helping, it often means something more significant is going on. 

According to Joint Vision Orthopaedic Surgeon Dr Jasan Dannaway, one of the biggest mistakes patients make is continuing to treat the symptoms without first understanding the underlying cause. 

"If someone has functional impairment, if they could move their shoulder before and now they can't, then something significant is going on. If they've had appropriate treatment and they're still not improving, it's time to ask whether we actually have the right diagnosis."  

Dr Jasan Dannaway specialises in diagnosing and treating shoulder, elbow, wrist and hand conditions at Joint Vision Orthopaedic Group.

Not All Shoulder Pain Is the Same

The shoulder is one of the most complex joints in the body. 

Pain can arise from tendons, muscles, ligaments, cartilage, nerves or the joint itself. While the symptoms can feel similar, the treatments can be completely different. 

Some of the most common causes include: 

• Rotator cuff tears  

• Frozen shoulder (adhesive capsulitis)  

• Shoulder arthritis  

• Tendon inflammation  

• Bursitis  

• Shoulder instability following injury  

Treating the wrong condition, even with good intentions, can delay recovery. 

One of the Biggest Myths About Shoulder Pain

Dr Dannaway says one of the most persistent myths surrounds rotator cuff tears. 

Many people believe that once you're over a certain age, surgery is no longer helpful. 

"That's simply not true," he says. 

While not every rotator cuff tear requires surgery, some full-thickness tears can gradually enlarge over time. Left untreated, they may eventually become impossible to repair, reducing the treatment options available. 

"The important thing isn't someone's age," Dr Dannaway explains. "It's understanding the type of tear, the quality of the tissue, how long it's been there and how much it's affects their function."  

When the Diagnosis Is Wrong

One of the most common scenarios Dr Dannaway sees is patients who have spent months treating a condition they don't actually have. 

A classic example is frozen shoulder versus shoulder arthritis. 

Both can cause stiffness and pain. 

Both make everyday activities difficult. 

But they're very different conditions requiring different management. 

"I still see patients who have been treated for frozen shoulder for six months or even a year before imaging shows they actually have shoulder arthritis," Dr Dannaway says. "Once you've got the correct diagnosis, the conversation changes completely."  

Why Imaging Matters

An X-ray or ultrasound is often enough to identify many shoulder conditions. 

Sometimes, however, more advanced imaging such as an MRI is required. 

Rather than ordering every scan immediately, Dr Dannaway believes imaging should answer a specific clinical question. 

"A scan is only useful if you know what you're looking for. That's why assessment and examination come first, followed by the right investigation for that individual patient."  

When Should You See a Specialist?

Most shoulder pain doesn't require surgery. 

In fact, many conditions improve with physiotherapy, activity modification, injections or time. 

However, there are situations where specialist assessment shouldn't be delayed. 

Dr Dannaway recommends seeking further assessment if: 

• You suddenly lose the ability to lift or use your arm.  

• Shoulder pain persists despite appropriate physiotherapy or other treatment.  

• Your pain continues to interfere with sleep or daily activities.  

• Your symptoms keep returning despite treatment.  

• You have ongoing stiffness or weakness that isn't improving.  

"People don't come to see me because they want surgery," he says. "They come because they want answers—and a solution to their problem."  

Does Seeing a Surgeon Mean You'll Need Surgery?

This is one of the biggest concerns patients have. 

The answer is no. 

Dr Dannaway believes an orthopaedic surgeon's role is to diagnose musculoskeletal conditions accurately and recommend the treatment most likely to achieve the best outcome. 

Sometimes that's rehabilitation. 

Sometimes it's an injection. 

Sometimes it's surgery. 

"The decision to operate always starts with making the right diagnosis," he says. "For many conditions we first exhaust non-operative treatment. Surgery becomes the right option only when it's likely to provide the greatest benefit for that particular patient."  

The Bottom Line

If your shoulder pain isn't improving, continuing to hope it will simply settle may not be the best strategy. 

Getting an accurate diagnosis early can help ensure you're receiving the right treatment—and in some cases, prevent conditions from becoming more difficult to treat later. 

Whether that treatment involves physiotherapy, rehabilitation or surgery depends entirely on what's causing the problem. 

The first step is understanding why your shoulder isn't getting better. 

Still struggling with shoulder pain?

If your shoulder pain isn't improving despite physiotherapy or other treatment, a specialist assessment may help identify the underlying cause and the most appropriate treatment.

Book an appointment with Dr Jasan Dannaway at Joint Vision Orthopaedic Group.

About the Author

Dr Jasan Dannaway is an orthopaedic surgeon specialising in disorders of the shoulder, elbow, wrist and hand. With a unique background as both a physiotherapist and surgeon, he combines expertise in diagnosis, rehabilitation and advanced surgical treatment to help patients achieve the best possible outcome. He consults at Joint Vision Orthopaedic Group in Wollongong.