Education, activity modification, analgesia, exercise-based rehabilitation and watchful waiting are sufficient to manage 95% of shoulder pain presentations in primary care, Australian experts say.

Their review in JAMA Internal Medicine says early routine imaging, which may detect incidental anomalies, remains common despite not being associated with better outcomes.

Among the studies cited is a 2016 randomised controlled trial that found no clinically significant difference in the primary outcome measure after one year between those who underwent ultrasound-tailored treatment and those who received usual care in patients with acute subacromial disorders.

This year, a Finnish cross-sectional study found that MRI revealed that rotator-cuff abnormalities were almost universal in those over 40 and showed poor concordance with symptoms.