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Am Fam Physician. 2023;107(5):503-512

Patient information: See related handout on shoulder pain.

This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.

Acute shoulder pain lasting less than six months is a common presentation to the primary care office. Shoulder injuries can involve any of the four shoulder joints, rotator cuff, neurovascular structures, clavicle or humerus fractures, and contiguous anatomy. Most acute shoulder injuries are the result of a fall or direct trauma in contact and collision sports. The most common shoulder pathologies seen in primary care are acromioclavicular and glenohumeral joint disease and rotator cuff injury. It is important to conduct a comprehensive history and physical examination to identify the mechanism of injury, localize the injury, and determine if surgical intervention is needed. Most patients with acute shoulder injuries can be treated conservatively using a sling for comfort and participating in a targeted musculoskeletal rehabilitation program. Surgery may be considered for treating middle third clavicle fractures and type III acromioclavicular sprains in active individuals, first-time glenohumeral dislocation in young athletes, and those with full-thickness rotator cuff tears. Surgery is indicated for types IV, V, and VI acromioclavicular joint injuries or displaced or unstable proximal humerus fractures. Urgent surgical referral is indicated for posterior sternoclavicular dislocations.

The location of the shoulder and its wide range of motion place it at risk for traumatic and nontraumatic injuries to the bony and soft tissue structures. Clavicle and proximal humerus fractures account for 12% and 4% to 6% of fractures in adults, respectively.1 Shoulder pain is common and affects 5% to 47% of adults each year.2 Acute shoulder pain lasting less than six months is a common presentation to primary care. The initial approach to acute shoulder injuries starts with a comprehensive history to understand the mechanism of injury and a complete shoulder examination to localize the injury.3,4

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