<keypoints>
- Red flags in shoulder pain indicate possible serious pathology (fracture, malignancy, infection, vascular/cardiac compromise) requiring urgent investigation or referral
- Key red flags include: unexplained deformity/swelling/erythema, significant weakness not due to pain, history or suspicion of malignancy, fevers/chills/malaise, unexplained sensory/motor deficits, and pulmonary or vascular compromise
- Referred pain from life-threatening conditions (e.g. ischaemic cardiac pain, diaphragmatic/pericardial irritation) can mimic shoulder pain and must be excluded
- Screen for red flags at every initial presentation of shoulder pain
</keypoints>
Red Flags for Shoulder Pain
The following signs and symptoms should be screened at initial presentation to exclude serious pathology:
Musculoskeletal Red Flags
- Unexplained deformity, swelling, or skin erythema
- Significant weakness not attributable to pain (e.g. positive drop test with acute trauma suggests acute rotator cuff tear or fracture)
- Open fractures or fractures with nerve/vascular compromise
- Hot, tense joint suggesting infection, inflammation, or tumour
Malignancy
- Past history of malignancy, particularly lung cancer (7% of bony metastases occur in the proximal humerus)
- Suspected malignancy: unexplained weight loss, loss of appetite, night pain, or other constitutional symptoms
Infection / Systemic Illness
- Fevers, chills, malaise
- Raised CRP, redness, swelling, with systemic features