Introduction
Shoulder pain is one of the most common musculoskeletal complaints seen in physiotherapy practice. Due to the shoulder joint’s high mobility and complex anatomy, it is prone to instability, overuse injuries, and degenerative changes. A structured shoulder pain physiotherapy approach ensures accurate diagnosis and effective rehabilitation.
This case-based discussion outlines a systematic assessment and management strategy.
Step 1: Subjective Assessment
A detailed history provides essential information. Important questions include:
- When did the pain begin?
- Was there a specific injury?
- Is the pain sharp, dull, or radiating?
- Does it worsen with overhead activity?
- Is there night pain?
Red flags such as severe trauma, sudden weakness, or neurological symptoms must be ruled out.
Understanding functional limitations—such as difficulty combing hair, reaching overhead, or lifting objects—guides further evaluation.
Step 2: Observation
Observe:
- Shoulder symmetry
- Muscle wasting
- Postural deviations
- Scapular positioning
Forward head posture and rounded shoulders commonly contribute to shoulder dysfunction.
Step 3: Range of Motion Assessment
Assess:
- Active range of motion
- Passive range of motion
- Painful arc (60°–120° abduction)
Restriction patterns may indicate:
- Frozen shoulder (global restriction)
- Impingement syndrome (painful arc)
- Rotator cuff involvement
Step 4: Strength Testing
Manual muscle testing of:
- Rotator cuff muscles
- Deltoid
- Scapular stabilizers
Weakness may indicate tendon injury or neuromuscular inhibition due to pain.
Step 5: Special Tests
Depending on findings, perform relevant tests such as:
- Neer’s test
- Hawkins-Kennedy test
- Empty can test
- Apprehension test
These help narrow differential diagnosis.
Step 6: Clinical Reasoning
Shoulder pain may result from:
- Rotator cuff tendinopathy
- Subacromial impingement
- Adhesive capsulitis
- Labral injury
- Postural dysfunction
Clinical reasoning integrates subjective and objective findings to identify the primary driver.
Step 7: Management Plan
Pain Management
- Activity modification
- Controlled mobility exercises
- Ice or other supportive modalities if needed
Mobility Restoration
- Joint mobilization
- Capsular stretching
- Pendulum exercises
Strengthening
- Rotator cuff strengthening
- Scapular stabilization exercises
- Progressive resistance training
Postural Correction
- Strengthening deep neck flexors
- Scapular retraction exercises
- Ergonomic advice
Step 8: Functional Training
Rehabilitation progresses to functional tasks such as:
- Overhead reaching
- Lifting mechanics
- Sport-specific drills
Progression depends on pain response and strength improvement.
When to Refer?
Referral is necessary if:
- Suspected full-thickness tear
- Persistent severe pain
- Neurological deficits
- No improvement with conservative care
Conclusion
Shoulder pain physiotherapy requires a structured and reasoning-based approach. Proper assessment, individualized rehabilitation, and progressive strengthening lead to optimal recovery.
Early intervention prevents chronic dysfunction and restores pain-free movement.