GP · musculoskeletal-presentations
Shoulder pain
Also known as Rotator cuff disease · Subacromial pain · Frozen shoulder · Adhesive capsulitis · Shoulder impingement
GP-fellowship guide to shoulder pain: age-based diagnosis (instability under 30, rotator cuff disease over 40), examination clusters and their accuracy limits, imaging rules, the management ladder from exercise therapy to subacromial injection, adhesive capsulitis phases and its one-to-three year course, placebo-surgery evidence against subacromial decompression, and referral triggers.
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Red flags
- Acute traumatic inability to raise the arm after a fall or dislocation suggests a massive cuff tear or dislocated shoulder needing urgent imaging
- Fever with a hot restricted joint is septic arthritis — emergency referral
- Constant night pain unrelated to movement, weight loss or a history of cancer raises malignancy — image rather than treat as tendinopathy
- Bilateral shoulder stiffness in a young man with spinal stiffness suggests axial spondyloarthritis — screen inflammatory features
Overview
Shoulder pain affects up to one in four adults at any time and ranks among the commonest musculoskeletal presentations in general practice. Most of it is rotator cuff related and most of that improves with exercise and time. The consultation sorts four syndromes — rotator cuff disease, adhesive capsulitis, acromioclavicular joint disorders and instability — while screening for referred pain and red flags.[4]
References10ShowHide
- [1]Carette S et al. Intraarticular corticosteroids, supervised physiotherapy, or a combination of the two in the treatment of adhesive capsulitis of the shoulder: a placebo-controlled trial. Arthritis Rheum, 2003.PMID 12632439
- [2]Ryans I et al. A randomized controlled trial of intra-articular triamcinolone and/or physiotherapy in shoulder capsulitis. Rheumatology (Oxford), 2005.PMID 15657070
- [3]Shaffer B et al. Frozen shoulder. A long-term follow-up. J Bone Joint Surg Am, 1992.PMID 1624489
- [4]Hegedus EJ et al. Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests. Br J Sports Med, 2012.PMID 22773322
- [5]Beard DJ et al. Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial. Lancet, 2018.PMID 29169668
- [6]Paavola M et al. Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: randomised, placebo surgery controlled clinical trial. BMJ, 2018.PMID 30026230
- [7]Naunton J et al. Effectiveness of progressive and resisted and non-progressive or non-resisted exercise in rotator cuff related shoulder pain: a systematic review and meta-analysis of randomized controlled trials. Clin Rehabil, 2020.PMID 32571081
- [8]Hopewell S et al. Progressive exercise compared with best-practice advice, with or without corticosteroid injection, for rotator cuff disorders: the GRASP factorial RCT. Health Technol Assess, 2021.PMID 34382931
- [9]Kanto K et al. Arthroscopic subacromial decompression versus placebo surgery for subacromial pain syndrome: 10 year follow-up of the FIMPACT randomised, placebo surgery controlled trial. BMJ, 2025.PMID 41330610
- [10]Hernigou P et al. The diabetic shoulder: association between diabetes mellitus and adhesive capsulitis - a systematic review and meta-analysis. Int Orthop, 2026.PMID 41896299