Shoulder pain — KFP-style written assessment

KFP 1 (10 marks)

A 47-year-old electrician presents with four months of right lateral shoulder pain, worse overhead and at night. He has a painful arc at 80–120 degrees and positive Hawkins-Kennedy. Passive range is full. He wants an ultrasound "to see the tear". ^[5]

1. State your working diagnosis and why imaging is not needed yet. (3) ^[5]
2. Outline first-line management with trial evidence. (4) ^[7][8]
3. He returns at six weeks unchanged despite exercise. What next? (3) ^[8]

Model answers

1. Rotator cuff related shoulder pain: over 40, overhead occupational loading, painful arc, positive Hawkins-Kennedy, full passive range. Imaging is not needed before treatment because degenerative cuff findings are common in asymptomatic shoulders and would not change first-line management; reserve ultrasound for persistent weakness after three months or when tear status would change decisions. ^[5]
2. Exercise therapy anchors care: progressive resisted programme taught properly (meta-analysis shows uncertain but plausible benefit — composite difference 15 points versus no treatment; non-progressive exercise showed none), activity modification within pain limits, short-course NSAIDs if tolerated. GRASP found progressive supervised exercise no better than one best-practice advice session at twelve months, so teach the home programme well and review at six-to-eight weeks. ^[7][8]
3. Offer subacromial corticosteroid injection as an adjunct: GRASP showed improvement at eight weeks (SPADI −5.64) that faded by six-to-twelve months. Continue the exercise programme through it; warn about temporary glucose rise if diabetic; review at three months. If still disabled at three-to-six months, refer for opinion — not automatically for decompression. ^[8]