Synopsis
Recognise rotator-cuff-related shoulder pain, separate pain inhibition from a clinically important tear, use imaging only for a decision, and deliver progressive rehabilitation while escalating traumatic weakness and other dangerous mimics promptly.
- Cuff-related pain usually causes lateral upper-arm pain with overhead reach or lying on that side; active movement is painful or weak while passive glenohumeral range remains comparatively preserved.
- Compare active and passive elevation, external rotation and internal rotation before provocative tests; no single painful-arc, Hawkins or empty-can manoeuvre proves one anatomical lesion.
- True weakness that persists after analgesia, external-rotation lag, drop-arm behaviour or immediate loss after trauma raises the likelihood of a large or full-thickness tear.
Key red flags
A sudden injury followed by inability to actively raise the arm despite preserved passive elevation suggests an acute substantial cuff tear and warrants expedited specialist assessment.
Investigation priorities
Distinguish cuff-related pain from a stiff joint, acute tear, cervical lesion and urgent referred cause.
Management branches
Atraumatic cuff-pattern pain is present without substantial weakness, passive restriction or systemic red flags.
- Explain the load-capacity model and identify work, sleep and activity goals before attaching significance to imaging findings.
- Modify the most provocative load temporarily while maintaining general use and beginning progressive cuff and scapular exercise.
Key medicines
Topical diclofenac gelFor 1.16% diclofenac gel, apply 2–4 g to the painful lateral shoulder per application, repeating three or four times a day for a brief trial within the licensed daily maximum.
Naproxen with gastroprotection when suitableUse naproxen 250–500 mg orally twice daily with or after food for the shortest effective course; add omeprazole 20 mg orally once daily while treatment continues when gastroprotection is indicated.