MSK · Shoulder

Persistent Shoulder Pain — When to Get an Ultrasound

Most shoulder pain is tendon trouble, and ultrasound is unusually good at looking at tendons. Here is what the pattern of pain suggests, what the scan sees, and where it stops.

Ultrasound transducer held against a shoulder during a musculoskeletal scan

Shoulder pain that has outlasted a few weeks of rest tends to come from one of a small number of places: the rotator cuff tendons, the bursa that sits above them, the biceps tendon at the front, or the capsule itself. Those structures are close to the surface, which is exactly the depth ultrasound handles best — and it can watch them move while you lift, which no static scan can do.

When shoulder pain needs urgent care

A visibly deformed shoulder after an injury, inability to move the arm at all following trauma, or a hot swollen shoulder with fever needs same-day assessment — A&E or NHS 111, not a booked scan. Pain spreading into the chest, jaw or arm with breathlessness should be treated as a possible cardiac emergency: call 999.

Patterns

What the pattern suggests

What you notice Commonly
Pain lifting the arm out to the side, worse overhead, sore lying on it at night Rotator cuff tendinopathy or impingement, often with bursitis
Sudden weakness after a fall or a heavy lift — struggling to hold the arm out A rotator cuff tear
Pain at the front of the shoulder, worse turning the palm up or carrying Biceps tendon problem
Stiffness dominating, movement limited in every direction, even when someone else moves it Frozen shoulder
Pain on top of the shoulder, tender to press, worse reaching across the body Acromioclavicular joint
Neck pain with pins and needles down the arm Coming from the neck, not the shoulder
Honestly

What ultrasound sees — and what needs MRI

Ultrasound sees well Ultrasound cannot see
Rotator cuff tendons — tendinopathy, partial and full-thickness tears The labrum — SLAP tears and instability lesions need MRI arthrography
Bursitis, and fluid around the tendons Inside the joint and the cartilage surfaces
The biceps tendon, including dislocation out of its groove Bone itself — fractures and bone marrow need X-ray or MRI
Calcific deposits in the tendon Nerve roots in the neck causing referred arm pain
The AC joint, and movement in real time as you lift Frozen shoulder directly — that is a clinical diagnosis, though a scan usefully rules out other causes

For rotator cuff tears specifically, ultrasound in experienced hands performs comparably to MRI — which is why it is a sensible first test rather than a lesser one. If the question is the labrum or the joint surface, MRI is the answer and we will say so.

At IUS London

How the appointment runs

  1. 1
    BookingNo referral needed, no preparation. Wear something that leaves the shoulder easy to reach. The appointment is 30 minutes.
  2. 2
    The scanWarm gel and a probe over the shoulder while you sit. We will ask you to move the arm through several positions so the tendons can be watched under load.
  3. 3
    Both sides if usefulComparing with the other shoulder often settles whether a finding is your normal or the problem.
  4. 4
    ResultsExplained on screen as we scan, with the written report usually with you within two hours — written for your GP, physiotherapist or orthopaedic surgeon to act on.
FAQs

Your questions answered

Is ultrasound as good as MRI for the shoulder?
For rotator cuff tendons and tears, in experienced hands, it performs comparably — with the advantage of watching the tendons move. For the labrum, cartilage or bone, MRI is clearly better. The right test depends on the question.
Do I need a GP referral?
No. You can book directly, and the report is written so your GP, physiotherapist or surgeon can act on it.
Can a scan diagnose frozen shoulder?
Not directly — frozen shoulder is diagnosed clinically from the pattern of restricted movement. A scan is still useful because it rules out the cuff tears and bursitis that can mimic it.
My shoulder hurts most at night. Does that mean something serious?
Night pain when lying on the shoulder is very typical of rotator cuff and bursal problems, and is not in itself a sign of anything sinister. Constant night pain unrelated to position, with fever or weight loss, is different and should go to your GP.
Should I have an X-ray as well?
If a fracture, arthritis or a bony cause is suspected, yes — X-ray shows bone, ultrasound shows soft tissue. They answer different questions and we do not offer X-ray here.
Can you inject the shoulder at the same time?
We provide diagnostic imaging only — no injections. If a scan shows something an injection would help, the report gives your GP or specialist what they need to arrange it.
Related

Where to go from here

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Read the guide →KneeKnee Pain After Exercise

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Read the guide →ScansMSK Ultrasound Scans

The full range of musculoskeletal scans we offer.

See scans →

Tendons watched while they work

A full shoulder assessment with the arm moved through range — cuff, bursa, biceps tendon and AC joint — explained on screen as we scan, with the written report usually within two hours.

From £169
Shoulder ultrasound scan

Shoulder scan

5a Lucerne Mews
Kensington, London W8 4ED
3 mins from Notting Hill Gate

This article is general information about shoulder pain, not individual medical advice. Shoulder pain after significant injury, or with fever, weakness or deformity, needs urgent assessment — see NHS guidance on shoulder pain. We provide diagnostic ultrasound only; we do not offer X-ray, MRI or injections.

Written and clinically reviewed by the HCPC-registered sonographers who perform this scan at IUS London — a CQC-registered diagnostic ultrasound clinic (Provider ID 1-2775844974). Your own findings are explained to you at the scan and set out in your report.

Author: Yianni Kiromitis, Senior Sonographer, HCPC RA38415 — over 20 years’ experience in NHS and private ultrasound
Medically reviewed: 9 August 2026