Shoulder pain is one of the most common musculoskeletal symptoms encountered in orthopaedic and rehabilitation practice. After low back pain and neck pain, it represents a major source of consultation, restricted activity, and work-related difficulty in adults. Population-based reviews have shown wide variation in the prevalence of shoulder pain across age groups and settings, reflecting differences in occupation, diagnostic definitions, pain duration, and health-seeking behaviour [1,2]. The shoulder joint permits a large range of motion, but this mobility depends on coordinated function of the rotator cuff, scapular stabilizers, capsule, and surrounding soft-tissue structures. Even modest pain or stiffness can therefore disturb essential activities such as dressing, grooming, lifting, reaching overhead, and sleeping on the affected side.

Chronic shoulder pain is not a single diagnostic entity. It includes rotator cuff-related pain, adhesive capsulitis, subacromial impingement, calcific tendinitis, glenohumeral osteoarthritis, and non-specific shoulder pain syndromes. Primary-care and specialist literature emphasize that shoulder disorders often persist beyond the acute phase, particularly in middle-aged and older individuals, persons with repetitive overhead activity, and workers exposed to heavy manual tasks [3,4]. Persistent symptoms can lead to guarded movement, reduced range of motion, altered muscle activation, analgesic dependence, and loss of confidence during daily tasks. Consequently, chronic shoulder pain becomes a functional problem rather than only a symptom of local pathology.

Assessment of chronic shoulder pain requires patient-centred outcome measures. The visual analogue scale provides a simple measure of perceived pain intensity and has been widely used in musculoskeletal research [9]. The Shoulder Pain and Disability Index is a validated self-administered instrument designed to quantify shoulder-related pain and disability through pain and functional subscales [5-8]. Quality-of-life tools such as the SF-12 complement these shoulder-specific measures by capturing broader physical and mental health effects [10,11]. Using these tools together allows a more complete description of disease burden and supports clinically meaningful interpretation of symptom severity.

The relationship between pain severity, functional limitation, and quality of life is clinically important. 

Study design and setting: This hospital-based observational cross-sectional study was conducted in the Department of Orthopaedics at Konaseema Institute of Medical Sciences & Research Foundation, Amalapuram, Andhra Pradesh, India. The study was designed to assess pain severity, functional limitation, and quality of life among patients presenting with chronic shoulder pain. Reporting was planned in accordance with principles recommended for observational studies [14]. Study period and sample size: The study was conducted from May 2025 to October 2025. A total of 100 eligible patients were included during the study period. This sample size was considered adequate for a descriptive hospital-based observational study intended to estimate the clinical pattern, pain category distribution, functional limitation, and quality-of-life status in the available patient population. Study population: Adult patients presenting with shoulder pain of at least three months duration were screened. Patients of either sex were included when they had clinically diagnosed chronic shoulder pain and were willing to provide informed consent. Patients with acute fracture or dislocation, recent shoulder surgery, inflammatory arthritis, neurological deficit affecting the upper limb, cervical radiculopathy as the predominant source of pain, malignancy, or incomplete clinical data were excluded. Bilateral cases were recorded separately as bilateral involvement, but patient-level analysis was retained. Data collection and variables: A structured proforma was used to collect demographic details, residence, body mass index category, duration of symptoms, side involved, dominant shoulder involvement, clinical diagnosis, night pain, restriction of shoulder movement, and analgesic use during the previous month. Clinical diagnosis was made by the treating orthopaedic team based on history and physical examination findings, supported by routine investigations when clinically indicated. Outcome assessment: Pain severity was measured using the visual analogue scale and categorized as mild, moderate, or severe [9]. Functional limitation was assessed using the Shoulder Pain and Disability Index, which includes pain and disability domains and provides a total score from 0 to 100, with higher scores indicating greater pain and disability [5-8]. Quality of life was assessed using SF-12 physical and mental component scores; lower scores indicated poorer quality of life [10,11]. Statistical analysis: Data were entered and analysed using descriptive statistical methods. Continuous variables were expressed as mean ± standard deviation. Categorical variables were presented as frequency and percentage. Mean VAS, SPADI, and SF-12 scores were compared across pain-severity categories. A p-value below 0.05 was considered statistically significant. Ethical considerations: Institutional ethical approval was obtained before starting the study. Written informed consent was obtained from all participants. Patient identity was kept confidential, and anonymized data were used for analysis.

A total of 100 patients with chronic shoulder pain were included in the study. The mean age of the study population was 51.4 ± 12.3 years. Females constituted 54.0% of participants. Most patients were aged between 41 and 60 years. The mean duration of shoulder pain was 8.6 ± 4.2 months. Baseline demographic and clinical characteristics are presented in Table 1.

The right shoulder was more commonly affected than the left shoulder. Dominant shoulder involvement was observed in 61.0% of patients. Rotator cuff-related shoulder pain was the most frequent clinical diagnosis, followed by adhesive capsulitis and shoulder impingement syndrome. Night pain was reported by 58.0% of patients, restriction of shoulder movement by 64.0%, and analgesic use during the previous month by 63.0%. These shoulder pain characteristics are summarized in Table 2.

Table 1. Baseline demographic and clinical profile of patients with chronic shoulder pain [n=100]

Table 2. Shoulder pain characteristics and clinical diagnosis [n=100]

The mean VAS score for pain was 6.2 ± 1.8. Moderate pain was observed in 48.0% of patients, while severe pain was present in 36.0%. Functional limitation was assessed using the Shoulder Pain and Disability Index. The mean SPADI total score was 48.7 ± 18.6, indicating moderate overall disability. Difficulty in overhead activity was the most frequent functional problem, reported by 72.0% of patients. Pain severity and functional limitation are shown in Table 3.

Quality of life was affected in patients with chronic shoulder pain. The mean SF-12 physical component score was 39.4 ± 8.7, and the mean SF-12 mental component score was 43.8 ± 9.1. Patients with severe pain had higher SPADI scores and lower SF-12 physical and mental component scores than those with mild or moderate pain. The association of pain severity with functional limitation and quality of life is displayed in Table 4.

Overall, chronic shoulder pain was commonly associated with moderate to severe pain intensity, functional restriction, and reduced quality of life. Pain severity showed a clear relationship with shoulder disability, and patients with severe pain had the poorest physical and mental quality-of-life scores.

Table 3. Pain severity and functional limitation among study participants [n=100]

Table 4. Association of pain severity with functional limitation and quality of life

The present observational study assessed pain severity, functional limitation, and quality of life among 100 patients with chronic shoulder pain. The study population was predominantly middle-aged, with a mean age of 51.4 years, and females formed a slightly larger proportion. This age profile is clinically expected because rotator cuff disease, adhesive capsulitis, degenerative changes, and repetitive-use shoulder disorders become more frequent from the fourth decade onward. Systematic reviews have also shown that shoulder pain prevalence varies widely but remains clinically important across adult and older populations [1,2].

Right-sided and dominant shoulder involvement were common in the present study. This pattern is relevant because dominant-side pain directly affects daily self-care, occupational activity, household tasks, and sleep positioning. Rotator cuff-related shoulder pain was the most frequent diagnosis, followed by adhesive capsulitis and impingement syndrome. These findings are consistent with primary-care descriptions of shoulder pain, where rotator cuff disorders and periarticular soft-tissue conditions are leading causes of persistent shoulder symptoms [3]. Occupational and repetitive mechanical factors have also been recognized as contributors to shoulder pain burden, particularly in working adults exposed to overhead activity and upper-limb load [4].

The mean VAS score in this study was 6.2, and 84.0% of patients had moderate or severe pain. This indicates that most patients presented only after pain had reached a clinically meaningful level. Pain intensity is an important prognostic marker in shoulder disorders and has been associated with poorer outcomes in previous reviews [2]. In our study, pain severity showed a graded association with functional limitation. Mean SPADI total score increased from 25.6 in mild pain to 62.4 in severe pain. This supports the expected biological and behavioural link between pain, guarded movement, stiffness, reduced shoulder use, and disability. The SPADI was appropriate for this assessment because it has been developed and validated specifically for shoulder pain and disability [5-8].

Quality of life was also reduced, especially in the physical component of SF-12. Patients with severe pain had lower physical and mental component scores than those with mild and moderate pain. This finding agrees with studies reporting that shoulder pain is closely linked with poorer health-related quality of life [12,13]. Imagama et al. reported that shoulder pain had a marked influence on both physical and mental quality-of-life domains among middle-aged and elderly participants [12]. Walankar et al. further showed that chronic shoulder pain is associated with psychological factors, higher disability, and reduced quality of life, particularly when chronic pain mechanisms are prominent [13].

The findings emphasize that chronic shoulder pain should not be assessed only by diagnosis or pain intensity. A combined evaluation using pain score, shoulder-specific disability score, and quality-of-life scale gives a stronger clinical picture. Patients with severe pain require early functional assessment, counselling, activity modification, targeted physiotherapy, and follow-up for sleep disturbance and mental well-being. In tertiary-care settings, this multidimensional approach can improve treatment planning and help identify patients at greater risk of persistent disability.

Limitations

This study had a single-centre cross-sectional design with a modest sample size, limiting generalizability. Imaging confirmation was not uniformly available for all diagnoses. Occupational load, psychological status, sleep disturbance severity, comorbid illness, and treatment history were not deeply quantified. Longitudinal follow-up was not included, so changes in pain, function, and quality of life after treatment were not assessed across time.

Chronic shoulder pain in this tertiary-care sample was associated with substantial pain, functional limitation, and reduced quality of life. Most patients had moderate or severe pain, and rotator cuff-related pain was the most common clinical diagnosis. Functional difficulty was prominent during overhead activity, lifting, dressing, grooming, and sleep. Higher pain severity was linked with greater SPADI disability and poorer SF-12 physical and mental component scores. These findings support routine use of structured pain, disability, and quality-of-life assessment in patients with chronic shoulder pain. Early identification of severe pain and functional restriction can guide rehabilitation-focused management, improve patient-centred care, and support timely referral for supervised physiotherapy and continued functional monitoring.

1. Lucas J, van Doorn P, Hegedus E, Lewis J, van der Windt D. A systematic review of the global prevalence and incidence of shoulder pain. BMC Musculoskelet Disord. 2022;23(1):1073. doi:10.1186/s12891-022-05973-8. PMID:36476476.
2. Luime JJ, Koes BW, Hendriksen IJM, Burdorf A, Verhagen AP, Miedema HS, et al. Prevalence and incidence of shoulder pain in the general population; a systematic review. Scand J Rheumatol. 2004;33(2):73-81. doi:10.1080/03009740310004667. PMID:15163107.
3. Mitchell C, Adebajo A, Hay E, Carr A. Shoulder pain: diagnosis and management in primary care. BMJ. 2005;331(7525):1124-1128. doi:10.1136/bmj.331.7525.1124. PMID:16282408.
4. Walker-Bone K, Palmer KT, Reading I, Coggon D, Cooper C. Prevalence and impact of musculoskeletal disorders of the upper limb in the general population. Arthritis Rheum. 2004;51(4):642-651. doi:10.1002/art.20535. PMID:15334439.
5. Roach KE, Budiman-Mak E, Songsiridej N, Lertratanakul Y. Development of a shoulder pain and disability index. Arthritis Care Res. 1991;4(4):143-149. PMID:11188601.
6. MacDermid JC, Solomon P, Prkachin K. The Shoulder Pain and Disability Index demonstrates factor, construct and longitudinal validity. BMC Musculoskelet Disord. 2006;7:12. doi:10.1186/1471-2474-7-12. PMID:16472394.
7. Hill CL, Lester S, Taylor AW, Shanahan ME, Gill TK. Factor structure and validity of the Shoulder Pain and Disability Index in a population-based study of people with shoulder symptoms. BMC Musculoskelet Disord. 2011;12:8. doi:10.1186/1471-2474-12-8. PMID:21226950.
8. Breckenridge JD, McAuley JH. Shoulder Pain and Disability Index (SPADI). J Physiother. 2011;57(3):197. doi:10.1016/S1836-9553(11)70045-5. PMID:21843839.
9. Delgado DA, Lambert BS, Boutris N, McCulloch PC, Robbins AB, Moreno MR, et al. Validation of digital visual analog scale pain scoring with a traditional paper-based visual analog scale in adults. J Am Acad Orthop Surg Glob Res Rev. 2018;2(3):e088. doi:10.5435/JAAOSGlobal-D-17-00088. PMID:30211382.
10. Ware J Jr, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34(3):220-233. doi:10.1097/00005650-199603000-00003. PMID:8628042.
11. Gandek B, Ware JE, Aaronson NK, Apolone G, Bjorner JB, Brazier JE, et al. Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA Project. J Clin Epidemiol. 1998;51(11):1171-1178. doi:10.1016/S0895-4356(98)00109-7. PMID:9817135.
12. Imagama S, Ando K, Kobayashi K, Seki T, Hamada T, Machino M, et al. Shoulder pain has most impact on poor quality of life among various types of musculoskeletal pain in middle-aged and elderly people: Yakumo study. Mod Rheumatol. 2020;30(3):568-572. doi:10.1080/14397595.2019.1623364. PMID:31132288.
13. Walankar PP, Panhale VP, Patil MM. Psychosocial factors, disability and quality of life in chronic shoulder pain patients with central sensitization. Health Psychol Res. 2020;8(2):8874. doi:10.4081/hpr.2020.8874. PMID:33123644.
14. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med. 2007;147(8):573-577. doi:10.7326/0003-4819-147-8-200710160-00010. PMID:17938396.