Shoulder Pain Red Flags: Warning Signs You Shouldn't Ignore

Key Takeaways

Some shoulder pain symptoms require immediate emergency care, especially chest pressure or difficulty breathing
Night pain that disrupts sleep and sudden weakness are urgent warning signs that need prompt medical evaluation
Understanding the difference between arthritis-related pain and other shoulder conditions helps you seek the right care at the right time
Don’t wait weeks with severe symptoms—early treatment often leads to better outcomes

Most shoulder pain comes and goes. You wake up stiff, it loosens through the day, and you manage. But sometimes shoulder pain isn’t just arthritis or overuse. Sometimes it’s your body sending an urgent message that something needs immediate attention.

Knowing which symptoms require a trip to the emergency room versus scheduling a doctor’s appointment can make a real difference in your outcome. Let’s walk through the warning signs that should never be ignored.

Emergency Red Flags: Call 911 or Go to the ER

These symptoms require immediate emergency care. Don’t wait, don’t “see how it goes,” and don’t drive yourself.

Chest Pressure or Pain with Shoulder Pain

If your shoulder pain comes with chest pressure, tightness, or discomfort—especially on the left side—this could signal a heart attack. Other heart attack warning signs include:

Pain radiating to your jaw, neck, or arm
Shortness of breath or difficulty breathing
Nausea, lightheadedness, or breaking out in a cold sweat
Unusual fatigue or feeling of doom

What to do: Call 911 immediately. Heart attacks can present differently in older adults, and shoulder pain might be the primary symptom you notice.

Sudden Severe Pain After an Injury

If you fall, have a car accident, or experience direct trauma to your shoulder and develop sudden, intense pain, you may have:

A shoulder dislocation (the bone has come out of the socket)
A fracture (broken bone in the shoulder, collarbone, or upper arm)
A complete rotator cuff tear

Red flags with injury:

Visible deformity or odd shoulder shape
Inability to move your arm at all
Numbness or tingling that spreads down your arm
Rapid swelling

What to do: Go to the emergency room. These injuries need immediate evaluation and treatment to prevent permanent damage.

Signs of Infection

Shoulder infections are less common but serious when they occur. Warning signs include:

High fever (above 101°F) with shoulder pain
Red, hot, swollen shoulder joint
Increasing pain despite rest
Recent surgery or injection in that shoulder

What to do: Seek emergency care. Joint infections can spread quickly and damage the shoulder permanently if not treated with antibiotics promptly.

Urgent Warning Signs: See a Doctor Within 24-48 Hours

These symptoms aren’t life-threatening emergencies, but they indicate conditions that need prompt medical attention. Don’t wait weeks for an appointment.

Night Pain That Disrupts Sleep

Shoulder pain that wakes you up at night or prevents you from sleeping is a significant warning sign. This type of pain often indicates:

Rotator cuff problems (tear or severe inflammation)
Frozen shoulder (adhesive capsulitis) developing
Advanced arthritis with inflammation
Shoulder bursitis

Why it matters: Night pain suggests active inflammation or mechanical problems that won’t improve on their own. The longer you wait, the more difficult treatment becomes.

Progressive Weakness

If you notice your shoulder getting weaker over days or weeks—not just sore, but actually weak—this needs evaluation. Examples include:

Difficulty lifting your arm to shoulder height
Unable to reach behind your back (like tucking in a shirt)
Dropping things more frequently
Struggling with tasks you could do last month

What this might mean: Progressive weakness can indicate a rotator cuff tear that’s getting worse, nerve compression, or arthritis advancing. Early treatment often prevents the need for surgery.

Swelling That Doesn’t Go Down

Some swelling after overdoing yard work is normal. But swelling that persists for more than a few days or keeps getting worse is a warning sign:

Visible puffiness around the shoulder joint
Warmth to the touch
Redness or skin changes
Swelling that spreads down your arm

Possible causes: Bursitis, severe inflammation, injury, or infection. All require medical evaluation.

Inability to Perform Daily Activities

When shoulder pain stops you from doing basic tasks, it’s time to see a doctor:

Can’t wash or brush your hair
Unable to reach items on shelves
Difficulty getting dressed
Can’t drive safely due to limited range of motion

Why this matters: Losing function means the problem is advancing. The sooner you address it, the better your chances of regaining full mobility.

Concerning Symptoms: Schedule an Appointment Soon

These symptoms warrant a doctor’s visit within the next week or two. They’re not emergencies, but they shouldn’t be ignored indefinitely.

Persistent Pain Beyond 2-3 Weeks

Shoulder pain from overdoing it should improve within a couple of weeks with rest and over-the-counter pain relievers. If it’s been three weeks and you’re not seeing improvement, it’s time to get evaluated.

What your doctor can determine:

Whether it’s arthritis or another condition
If imaging (X-ray or MRI) is needed
What treatment options might help

Clicking, Popping, or Grinding Sensations

Some noise from your shoulder is normal, especially with arthritis. But new, persistent clicking or grinding—especially with pain—can indicate:

Cartilage damage
Labral tear (the cartilage ring around the socket)
Arthritis progression
Loose bodies in the joint

When to worry: If the sounds come with pain, locking sensations, or limited movement.

Stiffness Getting Worse

Gradual loss of range of motion is a warning sign, particularly if:

You can’t raise your arm as high as you could a month ago
Reaching across your body becomes more difficult
Your shoulder feels “frozen” in certain positions
The stiffness doesn’t improve after warming up

Why this matters: Frozen shoulder and advanced arthritis both cause progressive stiffness. Treatment works best when started early.

Arthritis vs. Other Shoulder Conditions

Understanding the difference helps you know what to watch for.

Typical Arthritis Symptoms

Shoulder arthritis usually develops gradually:

Aching pain that’s worse with activity
Morning stiffness that improves within 30-60 minutes
Pain on the side or back of the shoulder
Gradual reduction in range of motion
Grinding sensation with movement

What helps: Rest, physical therapy, anti-inflammatory medication, and in some cases, injections.

Signs It’s Not Just Arthritis

Seek evaluation if you have:

Sudden onset: Arthritis pain develops slowly, not overnight
Sharp, catching pain: Suggests a tear rather than arthritis
Night pain: More common with rotator cuff problems
Numbness or tingling: May indicate nerve involvement
Pain radiating down your arm: Could be cervical spine or nerve issues

When to Seek Immediate vs. Scheduled Care

Here’s a quick reference guide:

Emergency Room (Now)

Chest pain with shoulder pain
Severe pain after injury
Shoulder dislocation or deformity
High fever with red, hot shoulder
Sudden inability to move arm

Urgent Care or Doctor (24-48 hours)

Night pain disrupting sleep
Progressive weakness
Persistent swelling
Significant loss of function

Schedule Appointment (1-2 weeks)

Pain lasting beyond 2-3 weeks
Gradual stiffness increasing
New clicking or grinding with pain
Want to discuss treatment options

What to Expect at Your Appointment

When you see your doctor for shoulder pain, be prepared to describe:

When the pain started and how it’s changed
What makes it better or worse
Whether it disrupts your sleep
What activities you can’t do anymore
Any injuries or events that preceded the pain

Your doctor will likely:

Examine your shoulder range of motion
Test your strength
Check for specific tender spots
Order imaging if needed (X-ray, MRI)
Discuss treatment options

Treatment Options for Shoulder Conditions

Depending on what’s causing your shoulder pain, treatment might include:

Physical therapy to restore strength and motion
Anti-inflammatory medications for pain and swelling
Cortisone injections for inflammation
Hyaluronic acid injections for arthritis cushioning (though less common in shoulders than knees)
Surgical options for severe tears or advanced arthritis

Early treatment often means simpler, less invasive options work better.

Don’t Wait on Serious Symptoms

The biggest mistake people make with shoulder pain is waiting too long. Whether it’s hoping it will go away on its own, not wanting to “bother” a doctor, or fear of what they might find, delays often make problems harder to treat.

Your shoulder is essential for independence—dressing yourself, preparing meals, staying active. When warning signs appear, getting them checked promptly gives you the best chance of maintaining your quality of life.

Frequently Asked Questions

How do I know if my shoulder pain is serious?

Serious shoulder pain typically involves night pain that disrupts sleep, progressive weakness, inability to perform daily activities, or pain that persists beyond 2-3 weeks despite rest. Emergency symptoms include chest pain with shoulder pain, severe pain after injury, or signs of infection like fever and redness.

Can shoulder arthritis cause night pain?

While shoulder arthritis typically causes daytime pain with activity, severe arthritis can cause night pain. However, night pain is more commonly associated with rotator cuff problems. Any persistent night pain warrants medical evaluation.

Should I go to the ER or urgent care for shoulder pain?

Go to the ER for chest pain with shoulder pain, severe pain after injury, visible deformity, or high fever with a red, hot shoulder. Visit urgent care or your doctor within 24-48 hours for night pain, progressive weakness, or persistent swelling without emergency features.

When is shoulder pain a sign of a heart attack?

Shoulder pain can be a heart attack symptom, especially if accompanied by chest pressure, shortness of breath, jaw pain, nausea, or unusual fatigue. Left shoulder pain is more commonly associated with heart attacks, but pain can occur in either shoulder. If you suspect a heart attack, call 911 immediately.

What does a rotator cuff tear feel like?

A rotator cuff tear often causes pain on the side or front of the shoulder, night pain that disrupts sleep, weakness when lifting or rotating your arm, and sometimes a clicking or popping sensation. Some tears happen suddenly with injury, while others develop gradually over time.

How long should I wait before seeing a doctor about shoulder pain?

For mild pain without concerning symptoms, give it 2-3 weeks of rest and over-the-counter pain relief. If pain persists beyond that timeframe, worsens, or is accompanied by weakness, night pain, or loss of function, schedule an appointment. Never wait with emergency symptoms.

This article is for informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider for diagnosis and treatment recommendations specific to your condition.

Last medically reviewed: February 2025