Over 40 years of age with a painful arc

 

If unresponsive to physiotherapy, analgesia +/- sub-acromial injection, then consider referral for ultrasound guided injection

 

If ultrasound reveals calcific tendonitis and still symptomatic, then consider referral for barbotage

 

If ultrasound reveals a cuff tear or impingement and still symptomatic, then consider referral for surgery

 

 

 

.