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Shoulder pain - Management
Basis for recommendation

  • The recommendations on how to assess a person with shoulder pain are based on a New Zealand guideline on the diagnosis and management of soft tissue shoulder injuries and related disorders [NZGG, 2004], a review of the management of shoulder pain in primary care [Mitchell, 2008], an article on shoulder problems in general practice [Hazleman, 2005], a review on the painful shoulder [Codsi, 2007], and a textbook of clinical examination [Munro, 1995].
  • CKS advises a general approach to assessment and has not included a large number of specific tests (e.g. for individual muscles, tendons, or joints) because:
    • There is no evidence that any specific test is both valid and reliable for the diagnosis of shoulder injuries [NZGG, 2004].
    • There is a lack of consensus on diagnostic criteria and clinical assessment, even between musculoskeletal specialists. Mixed shoulder disorders are common and over-differentiation between the numerous diagnostic categories is unlikely to alter usual primary care treatment and follow up [Mitchell, 2008].
  • CKS has not recommended routine investigations in primary care because, for most shoulder problems, the results of additional investigations (e.g. radiography, magnetic resonance imaging [MRI], computed tomography [CT], or ultrasonography) rarely influence treatment in primary care [Dutch College of General Practitioners (NHG), 1999].
    • The diagnosis of frozen shoulder is essentially clinical, with few specific laboratory tests or radiological markers [Dias et al, 2005].
    • Radiographs for frozen shoulder are usually normal and blood tests not usually done [NZGG, 2004].
    • Diagnostic ultrasound is a useful investigation for detecting tears of the rotator cuff, but this is more likely to be used in secondary care [NZGG, 2004].

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