Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
Shoulder pain, rotator-cuff disease and adhesive capsulitis
Essential points for quick revision.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Trauma, infection or referred emergency
Deformity after trauma, a hot swollen shoulder with systemic illness, an acutely ischaemic or neurologically impaired arm, or shoulder pain with chest, respiratory or abdominal features requires emergency care.
Action: Assess observations, circulation and neurology, immobilise and image suspected fracture or dislocation, arrange urgent aspiration for possible sepsis, and investigate cardiac, pulmonary, vascular or abdominal referral according to associated findings.
Synopsis
Localise shoulder pain by active and passive movement, distinguish rotator-cuff-related pain from adhesive capsulitis and glenohumeral disease, recognise acute tears and referred emergencies, and deliver staged rehabilitation, injection or surgical referral appropriately.
Compare active with passive range: painful or weak active movement with relatively preserved passive movement supports rotator-cuff-related pain, while global active and passive restriction suggests capsulitis or arthritis.
Adhesive capsulitis classically causes disproportionate loss of passive external rotation, followed by abduction and internal rotation, with gradual painful onset.
No single cuff manoeuvre is definitive; use pain location, strength after analgesia, range, trauma and combinations of resisted abduction, external rotation and lag signs.
Key red flags
Acute traumatic inability to raise the arm with true weakness, particularly in an older adult, can indicate a full-thickness cuff tear and needs expedited specialist imaging and referral.
Investigation priorities
01
First-line movement examinationFirst stepFirst line
Localise glenohumeral, cuff, acromioclavicular, cervical or referred pain and identify trauma, infection or major weakness.
Management branches
First-line assessmentUse movement to localise pain
Atraumatic or low-energy shoulder pain is present without deformity, systemic illness or neurovascular loss.
Screen chest, lung, abdomen, neck, systemic symptoms and cancer risk, then compare active range, passive range, cuff strength, acromioclavicular tenderness and distal neurology.
Classify a predominantly cuff-related, stiff glenohumeral, acromioclavicular, cervical or referred pattern without overclaiming a single special test.
Rotator-cuff-related pain is likely and no acute repairable tear or urgent lesion is suspected.
Key medicines
Topical diclofenac gelApply the product-directed amount to the painful region, commonly 2–4 g of 1.16% gel three or four times daily for a short trial, without exceeding the product maximum.
Naproxen with omeprazole when indicatedUse naproxen 250–500 mg orally twice daily with food for the shortest course; add omeprazole 20 mg orally once daily while taking it when gastroprotection is indicated.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.