Introduction
Shoulder pain significantly impairs movement, leading to considerable disability and impacting daily activities, from personal care to work capabilities. Globally, self-reported shoulder pain prevalence ranges from 16% to 26%, establishing it as the third most frequent musculoskeletal complaint in primary care settings. Annually, approximately 1% of adults seek consultation with general practitioners for newly onset shoulder pain. Occupations involving heavy lifting, repetitive or awkward movements, such as construction and hairdressing, elevate the risk of shoulder disorders. Physical factors like heavy lifting, repetitive motions in constrained postures, and vibration exposure contribute to symptom severity and functional impairment, while psychosocial elements also play a crucial role. Recent research highlights the commonality of chronic and recurrent shoulder pain.
Common shoulder conditions often present with overlapping clinical signs, and the ambiguity in diagnostic criteria coupled with inconsistencies in clinical evaluations complicates decisions regarding optimal treatment. This review proposes an evidence-driven strategy, employing a streamlined classification of shoulder problems. This approach integrates diagnostic methods suitable for primary care consultations and a “red flag” system designed to detect potentially serious underlying pathology.
Sources and Selection Criteria
This review synthesizes current consensus from systematic reviews and publications identified through comprehensive literature searches across Medline, CINAHL, AMED, the Cochrane Library (Central, CDSR, HTA, DARE), Clinical Evidence, Best Evidence, Embase, British Nursing Index, PEDro, Web of Science (covering social science and science citation indexes), and bmj.com. The search strategy incorporated terms including “shoulder pain,” “rotator cuff disorder,” “rotator cuff tear,” “frozen shoulder,” and “primary care.”
Our research identified six published systematic reviews focusing on interventions for shoulder disorders and one health technology assessment systematic review evaluating diagnostic tests for shoulder pain assessment. Furthermore, a topic-specific search within Clinical Evidence pinpointed the “Shoulder pain” section. We critically assessed and incorporated relevant findings from these sources to inform the diagnostic and management recommendations presented.
