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:
- 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.