Adult 40+ presents with non-traumatic shoulder pain.

A history is taken to determine:

  • the location, onset and duration of pain
  • any risk factors
  • aggravating and relieving factors
  • the patient’s occupational history.

A pain assessment should also be performed.

A physical examination is next, consisting of the following tests:

  • inspection
  • palpation
  • range of movement- both active and passive
  • special tests.

Next, establish if there are any red flags.

If there are red flags, treat, test and refer accordingly. If imaging, highlight all relevant details on a referral which should include:

  • the clinical question being addressed
  • a provisional diagnosis
  • relevant history and examinations
  • red flags
  • signature and date
  • availability of previous imaging.

If there are no red flags, make a working diagnosis.

Take a patient-centred approach to management.

  • Listen and acknowledge the patient’s concerns and ideas about their shoulder pain.
  • Establish a shared understanding with the patient.
  • Outline the patient’s management.
  • Arrange for an appropriate review.

Also take a conservative approach to management, which consists of:

  • stretching and strengthening exercises
  • pharmacological therapies, including non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol.