Management Guidelines www.sgsu.co.

uk
for Patients with
Shoulder Problems
RED FLAGS
Mass   /   swelling   •   Trauma   •   Suspected   malignancy   •   Redness/  
fever  •  Acute  Neurological  deficit  
URGENT REFERRAL
Age: 10-35
• Has the shoulder ever
come out of joint?
• Anxiety that the Referral for surgical
Instability stabilisation
shoulder may dislocate
with certain movements
or positions?

Age: 20+
• Hx of acute event Acute  Rotator  Cuff   Refer for possible rotator cuff
Tear   repair
• Pain lateral to acromion
+/- unable to elevate arm

Age: 20+ Refer for

• Pain over AC joint Acromioclavicular surgical
• Worse with movement joint disease opinion:
• Tender over AC joint Rest AC Joint
NSAID’s excision
Age: 35-75 physio
• Pain lateral to acromion injection Refer for
• Pain during shoulder Impingement / surgical opinion
elevation ‘painful arc’ Rotator cuff tear Subacromial
• Impingement tests Decompression
positive Rotator Cuff
Repair

Age: 40-60
• Reduction in active & < 6-12/12 intra-articular
passive range of movement Frozen  shoulder   injection and physiotherapy
Especially external rotation
• Acute painful phase
• Normal X-Ray > 6-12/12
MUA / capsular release
Age: 60+
• Reduction in active &
passive range of movement
Especially external rotation
Arthri0s   Refer for joint replacement
• No Acute painful phase
• Abnormal X-Ray
Mr.  Duncan  Tennent  FRCS(Orth)  2008