The causal link between imaging findings and shoulder symptoms is poor, with research reporting high rates of incidental findings in asymptomatic individuals.17,18 One study, which investigated ultrasound findings, reported that shoulder abnormalities were identified in 96% of men who did not have shoulder symptoms.17,19 The high prevalence of asymptomatic pathology identified in images of patients presenting with shoulder pain can complicate the interpretation of imaging results. This may lead to inappropriate treatment if the clinician associates signs and symptoms with the reported imaging findings in the absence of clinical correlation.8
Imaging modalities such as ultrasound and magnetic resonance imaging (MRI) have been reported as useful diagnostic tools in secondary care2 and may be indicated in some cases of non-traumatic shoulder pain, such as in the presence of red flags.20 In cases where imaging is warranted for red flags, X-ray is the recommended starting point due to its wide availability and accessibility.21
Definitive anatomical and pathological diagnosis of non-traumatic shoulder pain can be difficult and may not always be reliable.22-26
In recent years, approaches that reduce the emphasis on patho-anatomically based diagnostic labelling and highlight more pragmatic, functional assessment have been proposed.22,23 This approach is similar to the recommended approach to low back pain.
In this video interview, Professor Karen Ginn, musculoskeletal anatomist, physiotherapist and clinical researcher, describes her approach to assessing patients presenting with non-traumatic shoulder pain.