Background Shoulder pain (SP) is prevalent, costly, and linked to low quality of life, high pain levels, disability, and mental health issues. Despite guidelines, orthopaedic surgeons vary in surgical indicators and clinical decision-making. This study investigates if clinicians adhere to guidelines in an observational study. Methods In a French prospective multicentre study, four clinicians assessed patients with shoulder pain, recommended surgery or conservative management, and followed up at 4, 6, and 12 months. Comparative demographic and clinical data were used at baseline. Participants receiving surgery or conservative care within diagnostic and pain severity categories were compared to guidelines. An attrition analyses compared participants at baseline and 12-month follow-up. Results Of 189 participants, the majority of impingement and tendinopathy diagnoses were managed conservatively. More full-thickness tear diagnoses were recommended for surgical repair, and those recommended for surgery had more severe pain. Participants with high SMS completion (≥80%) and low SMS completion (<80%) were similar at baseline (based on age, sex, education, pain severity, duration, and disability) and at 12-month follow-up. Conclusion Clinicians recommended treatment in line with guidelines, emphasising rotator cuff tear presence and high pain intensity. Patients recommended surgery differed from those recommended conservative management, so future analyses should compare these treatment groups.
Hodgetts et al. (2026) studied this question.