Patient handout

Shoulder pain / rotator-cuff disorders

PRODUCTION

1. Your condition

This handout is for shoulder pain / rotator-cuff disorders. Your care team identified this based on: lateral / deltoid shoulder pain worse with overhead activity (subacromial / cuff) (jospt 2022 lafrance).

Other reasons your team may use this plan: painful mid-range arc ± cuff weakness (rotator-cuff spectrum) (jospt 2022 lafrance); progressive global stiffness with loss of passive external rotation (adhesive capsulitis) (uk frost rangan 2020); subluxation / dislocation event or apprehension (glenohumeral instability) (aaos 2019).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
education + activity modification	—	—	—	JOSPT 2022 Lafrance — reassurance, expectation-setting (slow recovery over weeks–months), de-emphasise structural labels; degenerative tears are common and often asymptomatic in older adults
progressive task-oriented rotator-cuff & scapular exercise programme	—	—	—	JOSPT 2022 Lafrance core recommendation; Steuri BJSM 2017 PMID 28588109 — exercise improves pain & function vs no/sham; CSAW (PMID 29169668) & FIMPACT 5-y (PMID 33020137) — exercise equals surgery; Cochrane 2019 (PMID 31813166) — repair little/no clinically important benefit over exercise for degenerative tears

Plan: Subacromial / rotator-cuff symptom-control ladder (exercise-first; NSAID + single transient injection adjuncts; surgical-referral gating) (JOSPT 2022 Lafrance; CSAW Beard 2018; Cochrane 2019)

3. Your action plan

Use these zones to know what to do based on how you feel.

GREEN — Improving with exercise

If you have:

Pain decreasing and function improving over weeks
Able to do the exercise programme
No new weakness, numbness, fever or systemic symptoms

Do this:

Keep doing the progressive exercise programme — recovery is slow (weeks to months) (JOSPT 2022 Lafrance)
Modify aggravating activities and work tasks rather than stopping the arm completely
Use NSAID or paracetamol only short-term for pain that limits your exercises, per your prescriber (JOSPT 2022 Lafrance)
Continue maintenance exercises even once you feel better to prevent recurrence

YELLOW — Not improving / persistent pain

If you have:

No improvement after several weeks of exercise
Pain or stiffness limiting daily activities or sleep
Shoulder getting progressively stiffer in all directions

Do this:

Continue exercises and contact your provider for review and re-assessment (JOSPT 2022 Lafrance)
A single steroid injection may be offered for short-term relief — its benefit is temporary (Bloom Cochrane 2012)
Frozen shoulder follows a long natural course — structured physiotherapy is the mainstay (UK FROST Rangan 2020)

Call your provider if:

No progress after an adequate exercise trial
Pain regularly waking you at night
Stiffness rapidly worsening in all directions

RED — Cannot-miss / urgent

If you have:

Sudden severe weakness after an injury (possible acute tear needing prompt surgery) (Cochrane 2019)
Fever with a hot, swollen, very painful shoulder (possible infection)
New numbness/weakness in the arm, chest pain, or pain radiating from the neck
Shoulder stuck out of joint after a dislocation, or cold/pale hand

Do this:

Seek urgent medical care / go to the emergency department now
For sudden weakness after trauma, ask specifically about a torn rotator cuff and timely surgical review (Cochrane 2019 PMID 31813166)
Bring your medication and medical history (diabetes, kidney disease, blood thinners)

Call your provider if:

Always seek emergency care for fever + hot joint, sudden post-injury weakness, vascular/neuro signs, or an unreduced dislocation (JOSPT 2022 Lafrance; AAOS 2019)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Acute trauma (fall on outstretched arm / forced abduction) followed by sudden cuff weakness in a younger active patient — time-critical surgical window (JOSPT 2022 Lafrance; Cochrane 2019 PMID 31813166)
Full-thickness-tear composite reaching a STRONG rule-IN LR+: the Gwark & Park 2019 multivariable model (age ≥67 + subscapularis tear + Patte retraction ≥2 + hs-CRP >1 mg/L + pain VAS ≥7) gives LR+ 19.07 / post-test 96% (PMID 31699076); chained with a lag-sign cluster that PERSISTS after a subacromial-lidocaine block (specificity/LR rises post-block — Bak 2010 PMID 20511030 Level-I) in the trauma/age-conditioned prior, the wired composite LR+ exceeds 20. The cluster LR is computed with conditional dependence, NOT as the product of the singles (Park 2005 PMID 15995110: painful-arc+drop-arm+infraspinatus → post-test 91% for a full-thickness tear from a defined cohort prior)
Fever / systemic illness with a hot, swollen, exquisitely painful shoulder and global motion loss (JOSPT 2022 Lafrance)(life-threatening)
Night pain, unexplained weight loss, smoking history, fixed/firm mass or constant non-mechanical pain (primary bone tumour, metastasis, Pancoast apical lung tumour) (AAOS 2019)
Abrupt severe shoulder/arm pain followed within days–weeks by patchy motor weakness/wasting, often after a viral illness or immunisation (AAOS 2019)
Dermatomal arm pain with positive Spurling / neck-driven symptoms, OR exertional / non-positional pain with cardiac risk — non-shoulder source (AAOS 2019; JOSPT 2022 Lafrance)

5. Follow-up

Exercise maintenance, activity / work modification, return-to-work and return-to-sport planning (JOSPT 2022 Lafrance return-to-work module), recurrence and red-flag return precautions; re-evaluate persistent / worsening symptoms for re-phenotyping or delayed imaging / surgical opinion (JOSPT 2022 Lafrance)

6. Sources

Guideline: JOSPT Rotator Cuff Disorders Clinical Practice Guideline 2022 (Lafrance) + AAOS Rotator Cuff CPG 2019 + ASES + BESS/BOA Frozen Shoulder Pathway + NICE CKS Shoulder Pain (2024)