Ask the expert: assessment of shoulder pain in primary care

### What you need to know Orthopaedic specialists Richard Murphy and Fiona Bintcliffe provide expert answers to GPs’ questions on shoulder pain, including advice on assessing patients with shoulder pain, clinical tests, when investigations may be indicated, and how to manage subacromial pain syndrome. You make a diagnosis of subacromial pain syndrome in a 58 year old man who presents with non-traumatic pain in his right shoulder. The pain is localised around the acromion and is made worse by lifting his arm. He has a painful arc from 60° to 120° when abducting his arm. ### Which of the following treatments should you recommend first? 1. Weekly corticosteroid injections for six weeks 2. Referral to a physiotherapist for taping the shoulder with kinesio tape 3. Referral to a physiotherapist for an exercise programme 4. Urgent referral to secondary care because of loss of function in the arm 5. Referral for hydrodilatation. 6. (answer at end of article). ### Common conditions Patients frequently present with more than one pathology at the same time.2 When a patient presents with shoulder pain, first rule out important acute diagnoses that need urgent referral to secondary care. Red flags are listed in box 1.34 Box 1 ### Red flagsRETURN TO TEXT