Shoulder
4 conditions · 9 special tests
Subjective Assessment
Goal: Narrow from 10 → 2–3 diagnoses
1Location of Pain
| Location | Suggests |
|---|---|
| Lateral arm / deltoid insertion | Rotator cuff related shoulder pain (RCRSP) |
| Top of shoulder (AC joint area) | Acromioclavicular (AC) joint pathology |
| Deep joint / diffuse / anterior | Glenohumeral joint, instability, or labrum |
| Neck / upper trapezius | Cervical referred pain (C4–C6 dermatome) |
| Posterior shoulder | Posterior capsule tightness or posterior labrum |
2Behaviour of Pain
| Feature | Suggests |
|---|---|
| Pain with movement (arc 60–120°) | Subacromial impingement / RCRSP |
| Night pain, unable to sleep on side | Rotator cuff tear, frozen shoulder, or red flag |
| Sudden onset after trauma | Acute tear, fracture, or dislocation |
| Gradual onset, progressive stiffness | Frozen shoulder (adhesive capsulitis) |
| Clicking, giving way, apprehension | Instability or labral tear |
| Burning, radiating to arm/hand | Cervical radiculopathy or thoracic outlet |
3Key Questions Cheat Sheet
Ask ONLY these high-yield questions — each one rules in or out a condition
"Can you sleep on that side?"
→ Assesses night pain and irritability level
"Does it hurt to lift your arm above your head?"
→ Screens for painful arc / impingement
"Did you have a fall, trauma, or sudden onset?"
→ Rules in/out acute tear, fracture, or dislocation
"Do you have any neck pain or tingling into your arm?"
→ Screens for cervical referral (radiculopathy)
"Does your arm feel weak or heavy?"
→ Assesses for massive cuff tear or neurological issue
"Has the shoulder progressively become stiffer?"
→ Screens for frozen shoulder (adhesive capsulitis)
"Any history of cancer, unexplained weight loss, or constant pain?"
→ Red flag screening
4Subjective Decision Flowchart
Subjective Assessment Flow
Clinical Question
Objective Assessment
Goal: Confirm hypothesis from subjective assessment
Active Movement Findings
Passive Movement Findings
Special Tests(hover ★ for evidence note)
Flex shoulder to 90°, flex elbow to 90°, internally rotate — pain = positive
Reproduction of pain in the anterior/lateral shoulder
Combine with: Neer Impingement Sign, Painful Arc — improves diagnostic accuracy
Stabilize scapula, passively flex arm in scapular plane — pain at end range = positive
Pain reproduced in the shoulder with full passive flexion
Combine with: Hawkins-Kennedy, Painful Arc — improves diagnostic accuracy
Abduct to 90° in scapular plane, IR (thumb down), resist downward force
Weakness or pain reproduction
Combine with: ER Lag Sign, Drop Arm Test — improves diagnostic accuracy
Passively ER the arm fully, release — arm falls into IR = positive
Arm falls back into internal rotation (true weakness)
Combine with: Empty Can (Jobe), Drop Arm Test — improves diagnostic accuracy
Abduct arm to 90°, patient slowly lowers — arm drops = positive
Arm drops suddenly or patient cannot control lowering
Combine with: Empty Can (Jobe), ER Lag Sign — improves diagnostic accuracy
Abduct to 90°, ER slowly — patient apprehension = positive
Patient reports feeling of shoulder "going out"
Combine with: Relocation Test — improves diagnostic accuracy
Follow apprehension test, apply posterior force on humeral head
Relief of apprehension with posterior pressure
Combine with: Apprehension Test — improves diagnostic accuracy
Flex to 90°, adduct 10°, IR (thumb down), resist downward force; repeat in ER
Pain in IR relieved in ER = SLAP; pain on top = AC joint
Extend and laterally flex neck to symptomatic side, apply axial compression
Reproduction of radicular symptoms into the arm
Objective Assessment Flowchart
Objective Assessment Flow
Clinical Question
Differential Diagnosis
Goal: Turn findings into a clinical diagnosis
Clinical Pearl
Use the decision tree below to systematically work through your findings. The breadcrumb trail shows your full reasoning path. Use YES (green) / NO (red) to navigate. When two diagnoses seem equally likely, use the Condition Comparison table below.
Differential Diagnosis Decision Tree
Clinical Question
Side-by-Side Condition Comparison
Condition Comparison — Differentiating Similar Diagnoses
| Feature | Rotator Cuff Tendinopathy | Frozen Shoulder (Adhesive Capsulitis) |
|---|---|---|
| Onset | Gradual, often activity-related | Gradual, often spontaneous or post-trauma |
| ROM restriction | Painful arc (60–120°), full passive ROM | Global restriction — ER most limited, then ABD, IR |
| Night pain | Common when lying on affected side | Severe, often wakes patient from sleep |
| Passive movement | Full range, pain at end range only | Markedly restricted in all planes (capsular pattern) |
| Key test | Hawkins-Kennedy, Neer (+) | Capsular pattern on passive ROM assessment |
| Age group | 35–60 years, active population | 40–65 years, more common in women, diabetics |
| Duration | Weeks to months | 12–36 months (3 stages) |
| Treatment focus | Load management, rotator cuff strengthening | Stretching, mobilisation, corticosteroid injection |
Common Conditions
Tap a condition to expand Signs, Tests, Treatment & Exercises
Treatment Quick Guide
Universal progressive framework — adapt to each condition
Condition-Specific Treatment Phases
For detailed phase-by-phase protocols tailored to each diagnosis, open the condition card below:
Progression Rules
Exercise Prescription Cheat Sheet
Keep it simple and evidence-based
| Goal | Sets | Reps / Duration | Rest |
|---|---|---|---|
| Pain Relief (Isometrics) | 5 | 45 sec hold | 1–2 min |
| Strength (Heavy Slow Resistance) | 3–4 | 8–12 | 1–2 min |
| Endurance | 2–3 | 15–20 | 30–60 sec |
| Mobility / Stretching | 3 | 30–60 sec hold | 30 sec |
Full Exercise Prescription Guide
Top exercises, clinical pearls & dosage framework for Shoulder
Outcome Measures
Validated tools to track progress and demonstrate clinical change
| Measure | Abbrev. | Best For | Description | MDC / MCID |
|---|---|---|---|---|
| Shoulder Pain and Disability Index | SPADI | All shoulder conditions | 13-item self-report measuring shoulder pain and functional disability | MCID: 13 points (0–100 scale) |
| Quick DASH | QuickDASH | Upper limb / shoulder | 11-item questionnaire for upper extremity disability and symptoms | MCID: 16 points (0–100 scale) |
| Oxford Shoulder Score | OSS | Rotator cuff, OA, post-surgical | 12-item patient-reported outcome for shoulder function | MCID: 5 points (0–48 scale) |
| Shoulder Instability Questionnaire | SIQ | Glenohumeral instability | Measures disability and symptoms related to shoulder instability | MCID: 10.4 points |
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Shoulder Clinical Pearls
High-yield clinical insights — the knowledge that changes your practice