Chronic pain in the shoulder joint has a high incidence and bothers a large number of people, especially middle-aged people around 50 years old. When chronic pain in the shoulder joint occurs, you should go to the hospital for consultation to clarify your condition and receive standardized treatment in order to avoid after-effects. Here is a reminder that when you go for consultation, it is better to go to a big hospital and see a doctor who specializes in shoulder joints, because a general orthopedic surgeon or arthropedic surgeon may not be able to give you the best diagnosis and treatment advice. Now let’s talk about the common causes of pain and treatment. I. Frozen shoulder: Frozen shoulder is one of the most common causes of shoulder pain and is categorized into primary, secondary and traumatic frozen shoulder. Primary frozen shoulder is more common in women, and can develop bilaterally. Middle-aged people are prone to it, so it is commonly called “50 shoulders”, and some doctors will call it “frozen shoulder”. Usually it can be self-healing, with a duration of 1-3 years, but some patients will have functional limitations. Frozen shoulder often has an insidious onset, but is often aggravated by chance events. It often manifests as persistent pain in the shoulder joint, with some patients waking up at night in pain and being unable to sleep. Then the range of motion of the joint gradually decreases, especially the difficulty in over head movement and hand extension to the back, and in severe cases, even inactivity. For “frozen shoulder”, proper treatment should be taken as early as possible to shorten the course of the disease and relieve the pain. The disease is mainly treated by non-surgical treatment, through pain relief and rehabilitation to restore the function of the shoulder joint. If the non-surgical treatment is ineffective in a few patients, shoulder arthroscopy can be carried out, and most of the patients can regain their functions. Shoulder impingement syndrome: The incidence of shoulder impingement syndrome is also high, which can be categorized into external impingement and internal impingement. The most common shoulder impingement is subacromial impingement, which belongs to one kind of external impingement, sometimes accompanied by rotator cuff injury. Like frozen shoulder, the disease is common in middle age, and sometimes it is difficult to distinguish the two. Clinical manifestations include shoulder pain, night pain, inability to lie on the affected side, and weakness of the affected limb. Most patients require formal conservative treatment, including improvement of lifestyle habits, rest of the affected limb, medication for pain relief, physical therapy, and moderate functional exercises. Non-surgical treatment often lasts for more than 3 months, and if it is ineffective or the symptoms continue to aggravate, surgical treatment is needed. At present, arthroscopic acromial decompression is the “gold standard” for the treatment of this disease, and the surgical effect is good. Rotator cuff injury: sometimes it exists together with shoulder impingement syndrome. Rotator cuff is an important structure for stabilizing and exercising the shoulder joint, including 4 groups of tendons, and the most vulnerable one is supraspinatus tendon. Clinical symptoms are similar to those of impingement syndrome, including pain, weakness, and stiffness, but the weakness may be greater than that of impingement syndrome. Treatment is similar to impingement syndrome, and most patients can improve with conservative treatment, while arthroscopic treatment is only considered for those who fail conservative treatment. In patients with a high demand for motion, surgery can be performed at an early stage. The cost of this surgery is higher than the treatment of impingement syndrome because the tendon has to be sutured. IV. Degenerative shoulder arthritis, acromioclavicular arthritis, biceps long head tendonitis, etc.: Degenerative arthritis can be interpreted as an aging and strain of the joints, many secondary to early trauma. Because of the lack of weight-bearing, degenerative shoulder arthritis is less common than in the lower extremities, but not uncommon, and when chronic shoulder pain persists without relief, x-rays should be taken to rule out arthritis. If degenerative acromioclavicular arthritis is diagnosed, most patients can improve their symptoms through conservative treatment if they do not require much exercise; some patients who do not respond well to treatment may need to undergo arthroscopic surgery, and in severe cases where the pain continues to worsen and shoulder function is severely limited, shoulder replacement surgery will be required. The diagnosis of acromioclavicular arthritis can be confirmed by physical examination, X-ray and MR. Most of the patients can be relieved by conservative treatment, while arthroscopic surgery or developmental surgery is feasible for severe cases, with a high rate of excellent results. Biceps long head tendonitis can be diagnosed through physical examination and MR, and most of the patients will be relieved through conservative treatment, and generally do not need surgery, but when combined with other parts of the shoulder joint that require surgery, the tendon can be treated together. Fifth, calcific rotator cuff tendonitis: the incidence of this disease is not low, but only a part of patients with obvious symptoms. Its clinical manifestation is shoulder joint pain and secondary decrease in shoulder joint mobility. According to the degree and duration of symptoms, it is divided into acute, subacute and chronic phases. The acute phase can be characterized by sudden, severe shoulder pain, with significant pain at night. Taking X-ray can see calcified foci in the rotator cuff. Most patients can be relieved by conservative treatment, including drug analgesia, physical therapy, local hormone injection, and improvement of life habits. For patients whose symptoms continue to worsen, they need to undergo shoulder arthroscopy, which is minimally invasive and has a fast postoperative recovery, reducing the risk of chronic shoulder pain and secondary frozen shoulder.