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Approach to the diagnosis of shoulder pain using physical exam and ultrasound: an evidence-based approach

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Purpose of review

The differentiation and diagnosis of shoulder pain is a complex process. Developing an evidence-based approach to shoulder pain can provide the clinician focused, validated physical exam maneuvers and imaging modalities to promote timely and accurate diagnosis. In this paper, we will attempt to provide an evidence-based approach to three common causes of shoulder pain (Subacromial impingement, rotator cuff pathology, and adhesive capsulitis) and the diagnostic strength of physical exam and ultrasound for these pathologies.

Recent findings

The current body of literature shows a mixed landscape of evidence with regard to physical exam maneuvers. Musculoskeletal ultrasound is a well-validated tool in the evaluation of extra articular shoulder pathology and when combined with plain film radiographs may be sufficient to characterize a majority of shoulder pathology.


Developing an evidence-based approach to the evaluation of shoulder pain helps to focus the physical exam, imaging, and eventual management. The current literature shows no single exam maneuver as being perfectly sensitive or specific for differentiating pathology. Utilizing selected combinations of physical exam tests that individually provide either high sensitivity or specificity may yield a more targeted diagnosis. Additionally, incorporating MSK-US as a routine extension of the physical exam can expedite diagnosis and allow for the timely initiation of appropriate treatments.

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Correspondence to Alfred C. Gellhorn.

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Michael F. Saulle and Alfred Gellhorn declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Musculoskeletal Rehabilitation

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Saulle, M., Gellhorn, A.C. Approach to the diagnosis of shoulder pain using physical exam and ultrasound: an evidence-based approach. Curr Phys Med Rehabil Rep 5, 1–11 (2017). https://doi.org/10.1007/s40141-017-0149-6

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  • Shoulder
  • Ultrasound
  • Physical exam
  • Evidence-based
  • Impingement
  • Rotator cuff