Shoulder pain: why early scans may not help
18 Aug 2026
Shoulder pain is one of the most common musculoskeletal problems managed in general practice. Researchers reviewed existing evidence and found that routine X-rays, ultrasounds and MRIs are often not needed for people with subacromial shoulder pain.
The review found that scan results do not always explain why a person is in pain. Changes seen in the shoulder are also common in people who have no symptoms and may simply reflect normal ageing.
Instead, GPs are encouraged to first take a detailed history and perform a physical examination. Once serious conditions have been ruled out, treatment can focus on reassurance, staying active, modifying activities when needed and managing symptoms.
Most people with common shoulder pain improve over time with minimal treatment, according to the review.
The researchers say early MRI scans do not appear to improve long-term recovery. Avoiding unnecessary imaging may also reduce anxiety, overdiagnosis and treatments that are unlikely to help.
Imaging or specialist referral may still be appropriate when there are concerning symptoms or when a serious condition is suspected.
The review also questioned some commonly used treatments. It found that subacromial decompression surgery does not provide meaningful benefit compared with non-surgical care or placebo surgery.
For corticosteroid injections, the researchers said image guidance may not provide better results than using the patient’s anatomy to guide the injection when an injection is appropriate.
The authors stress that reducing unnecessary tests does not mean doing nothing. GPs still have an important role in identifying serious conditions, monitoring recovery, managing symptoms and supporting patients throughout treatment.
Shoulder pain: why early scans may not help
Source: Monash University review published in JAMA Internal Medicine; RACGP First do no harm: A guide to choosing wisely in general practice.