Version June 2024
| History and epidemiology | Examination findings | Likely diagnosis |
| Generally age >40 Pain increases with reaching Frequent repetitive activity at or above shoulder | Subacromial tenderness Pain with Apley scratch tests Normal passive range of motion Normal strength but pain with testing midarc abduction and/or external rotation Pain with impingement testing (Neer and Hawkins tests) | Rotator cuff tendinopathy (very common) |
| Same as rotator cuff tendinopathy, but weakness present Midde aged and older | Same as rotator cuff tendinopathy but weakness often present with resisted abduction and/or external rotation | Rotator cuff tear |
| Past history of rotator cuff tendinopathy, diabetes, or immobility for any reason Complaint of decreased motion +/- pain | Significant decrease in range of motion, both active and passive | Adhesive capsulitis |
| Past history of shoulder trauma | Decrease in range of motion - both active and passive | Glenohumoral osteoarthritis (uncommon) |
| Pain increases when carrying objects with elbows bent (eg, shopping bags) or lifting overhead | Bicipital groove tenderness Pain with resisted elbow flexion or supination | Biceps tendinopathy |
| Sudden increase in shoulder pain with "Popeye" deformity (ie, prominent ipsilateral distal bicep) | Obvious biceps deformity Pain with resisted elbow flexion or supination | Biceps tendon rupture |
| Recent fall onto adducted arm Focal AC joint pain | AC joint tenderness with possible stepoff Pain with adduction of injured arm Clavicle elevation on x-ray with higher grade sprain | Acromioclavicular injury |
| Focal AC joint pain without recent trauma | AC joint tenderness Pain with adduction of injured arm | Acromioclavicular osteoarthritis |
| Generally age <40 Overhead athletes Nonspecific symptoms | Sulcus test shows increased motion Apprehension, relocation, and release tests positive | Multidirectional shoulder instability (may have concomitant rotator cuff tear) |
| Poor muscular development, frequent repetitive to-and-fro motion (eg, ironing), and direct pressure (eg, backpack) are common causes | Superiomedial scapular border tender (performed with ipsilateral arm adducted) | Subscapular bursitis |
| Sedentary (eg, works at desk job); poor posture with rounded upper back | Abnormal, uncoordinated scapulothoracic and glenohumoral motion Wall push off may reveal mild scapular winging Stabilization of scapula by examiner improves shoulder strength | Scapular stabilizer muscle weakness |
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