Pain in shoulder region commonly due to rotator cuff disease, frozen shoulder, OA, or impingement.
History taking
- • Onset, mechanism, pain on overhead activities, night pain, stiffness
- • Diabetes, prior injury, occupation, sport
Examination
- • ROM (active vs passive), Hawkins-Kennedy, Neer impingement
- • Empty can (supraspinatus), external rotation (infraspinatus), lift-off (subscapularis)
- • Painful arc 60–120°
Red flags
- • Trauma with deformity (dislocation, fracture)
- • Fever, hot swollen joint
- • Mass or neurological deficit
Differential diagnosis
- • Rotator cuff tendinopathy/tear, adhesive capsulitis (frozen shoulder), glenohumeral OA, acromioclavicular pathology, referred (cervical, cardiac)
Recommended investigations
- • X-ray shoulder, USG for cuff tears, MRI for further evaluation
Diagnosis
- • Clinical ± imaging
Initial treatment / management
- • Activity modification, ice/heat, analgesics
- • Structured physiotherapy
- • Subacromial steroid injection if no improvement at 6 weeks
- • Surgery for full-thickness tears in active patient or failed conservative
Prescription examples
- • Tab Naproxen 500 mg PO BD x 7 d
- • Physiotherapy referral
- • Local steroid: Methylprednisolone 40 mg + Lignocaine 2% subacromially
Follow-up advice
- • Review in 6 weeks; if no improvement, MRI
Patient counselling
- • Adherence to exercises is key
- • Frozen shoulder usually self-limits over 18–24 months
Referral criteria
- • Full-thickness rotator cuff tear in young/active
- • Recurrent dislocation, suspected malignancy
Clinical pearls
- • Diabetics have higher frozen shoulder risk; tighter glucose control helps
- • Pseudoparesis of arm in older patient — suspect massive cuff tear
References
- • AAOS Clinical Practice Guidelines
Educational outpatient guide — verify against local guidelines before clinical use.
