Monash University researchers have reviewed existing evidence and concluded that most shoulder problems get better with self-management, education and time, challenging widespread clinical reliance on early imaging and surgical interventions.
The landmark review, published in JAMA Internal Medicine, provides general practitioners and physiotherapists with an updated roadmap for managing shoulder pain.
It suggests that simple supportive care delivers better patient outcomes in most cases, rather than unnecessary scans and invasive procedures.
Shoulder pain affects nearly one in six adults each year, making it the third most common musculoskeletal complaint in primary care, trailing only behind back and knee conditions.
For most of these patients, the review emphasises that routine scans (X-rays, ultrasounds or MRIs) are not recommended because what appears on a scan often does not explain a person’s pain.
Instead, clinicians should focus on understanding the patient’s symptoms and history, conducting a physical examination, providing reassurance about their expected recovery, and recommending activity modifications, symptom relief or a wait-and-see approach where appropriate.
Lead author Dr Romi Haas, Research Fellow at the Monash School of Public Health and Preventive Medicine, said initial assessments should focus on ruling out serious underlying causes, such as infections, tumours or broken bones, and distinguishing localised shoulder pain from referred pain, such as pain originating from the neck or heart.
“The traditional approach has been to look for a structural flaw by scanning the shoulder, assuming that if you can identify the source of the pain, you can fix it,” Dr Haas said.
“However, global evidence shows these findings are often just normal signs of ageing, akin to grey hair or wrinkles.
“Unwarranted imaging can wrongly attribute a person’s pain to these normal age-related changes, causing undue worry, overdiagnosis and treatments they don’t need. Importantly, early scans don’t improve long-term recovery.”
Subacromial pain is the most common presentation of shoulder pain. It’s usually felt around the top and outside of the shoulder, and can worsen when lifting or reaching with the arm, or when sleeping on that side.
“Structural labels like ‘bursitis’ or ‘tendon tears’ make people think their shoulder is damaged and needs fixing,” Dr Haas said.
“Shifting to location-based labels, such as ‘subacromial pain’, helps reassure patients that it’s safe to keep moving while they manage their symptoms and recover.”
Co-author Dr Thomas Ibounig, a shoulder and elbow surgeon at Helsinki University Hospital in Finland, said the evidence is just as relevant for surgeons as it is for other clinicians.
“High-quality evidence has found that a common shoulder operation, which removes bone and tissue to create more space for the tendons, provides no meaningful benefit over a dummy procedure, where incisions are still cut into a patient, but nothing has been repaired,” Dr Ibounig said.
“It’s a reminder that pain isn’t always caused by an anatomical or structural problem we can simply fix with surgery.
“This guidance helps clinicians explain that clearly, so patients aren’t unnecessarily worried or pushed toward treatments they don’t need.”
Dr Haas said the same principle applies to corticosteroid injections.
“They can provide short-term pain relief, but they don’t routinely need to be guided by imaging,” Dr Haas said.
“Evidence shows an injection given by a doctor using the patient’s physical anatomy as a guide works just as well, without the additional cost or inconvenience of imaging.”
Senior author, Professor Rachelle Buchbinder, a rheumatologist and clinical epidemiologist from the Monash School of Public Health and Preventive Medicine, said most people recover from shoulder pain within one year, although often much sooner.
“Based on a long-term study of 526 adults with new shoulder concerns, followed for more than 10 years, almost 80 per cent experienced satisfactory improvement, through watchful waiting or anti-inflammatory medication,” Professor Buchbinder said.
“Our new guidance is a practical tool and a reassuring reminder for clinicians.
“It gives GPs, physios and surgeons the evidence base they need to reassure patients that self-management, time, and targeted advice are usually the safest and most effective path to recovery.”
Read the research paper: https://doi.org/10.1001/jamainternmed.2026.3135
