Questionnaire/history Older 60 years? Deep joint pain and restriction of activities (eg putting on a jacket)? Past medical history? Current medication? Drug allergies? Examination: Global restriction in active and passive shoulder movements with a severe loss of passive external rotation? Investigations: X-ray (AP and axillary views) (needed to confirm diagnosis) Management: Findings explained Advised paracetamol +/- ibuprofen prn Strengthening exercise Arthritis Research UK PIL ‘Exercise to manage shoulder pain’ given Referral for physiotherapy offered Review if worsening symptoms or no improvement Reference(s): NICE CKS: Shoulder pain: Scenario: Glenohumeral joint osteoarthritis