Regional musculoskeletal conditions: shoulder pain

About half the population has at least one episode of shoulder pain yearly. History and clinical examination are cornerstones in the evaluation of the patient. Shoulder pain at the work place is associated with job strain: lack of control and work with elevated arms and hand tools. Clinical skills and knowledge about red and yellow flags and biomechanics are essential to perform a systematic and reliable evaluation. The diagnostic validity of clinical tests for rotator cuff tear, impingement syndrome and superior labral tears is equal or better than ultrasound and magnetic resonance imaging. Non-steroidal anti-inflammatory drugs and cortico-steroidal injections have documented short-term pain relief. Additionally, the physician should attempt to give the patient simple advice and reinforce active coping strategies. One randomized study suggests that a proper physiotherapy regimen and surgery are equally effective for the impingement syndrome. Further research should address the cost-effectiveness of diagnostic methods and treatments.