Shoulder pain
in Rockhampton
Shoulder pain is one of the most common reasons patients are referred to the practice. The diagnosis matters more than the symptom — most shoulder pain has a clear cause, and the right treatment depends on which one. Patients are seen at Mater Private Hospital Rockhampton from across Central Queensland.
What is going on
The shoulder is a complex joint where pain can come from many sources — the rotator cuff, the bursa, the joint capsule, the glenohumeral and AC joint surfaces, the long head of biceps, and referred pain from the neck. Each of these has a characteristic story and examination signature, and each has a different treatment pathway and recovery profile.
The first job of a shoulder consult is establishing which structure or combination of structures is driving the pain. Most shoulder problems are diagnosed in clinic on history and examination, with imaging confirming the picture. Treatment ranges from a single corticosteroid injection through structured physiotherapy to arthroscopic or replacement surgery — the right pathway is the one that matches the diagnosis. The shoulder anatomy education page sets out how the joint works as background for the diagnoses below.
The diagnoses behind the pain
Each of the conditions below can produce shoulder pain. Some are more likely at certain ages and after certain events; the consult sorts out which fits the presentation.
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Rotator cuff disorders
Tendinopathy, partial tear, or full-thickness tear of the rotator cuff — by far the most common cause of shoulder pain in adults over 40. Pain at night, weakness reaching overhead, and difficulty sleeping on the affected side.
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Subacromial impingement and bursitis
Pinching of the cuff and bursa under the acromion. Painful arc on overhead lifting, often with mechanical catching. Many cases settle with physiotherapy and a single corticosteroid injection; the minority that don't are candidates for arthroscopic decompression.
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Frozen shoulder
Adhesive capsulitis — inflammation and contracture of the joint capsule. Severe night pain that progresses to global stiffness, particularly external rotation. Most settle over 12–24 months without surgery, but the painful phase is genuinely disabling and often benefits from hydrodilatation.
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Shoulder arthritis
Wear of the glenohumeral cartilage, usually in patients over 60 or after old shoulder injury. Deep aching pain on movement, grinding, and progressive loss of range. Treatment runs from physiotherapy and injection through to total or reverse shoulder replacement.
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AC joint arthritis
Wear of the acromioclavicular joint at the top of the shoulder. Point tenderness over the AC joint, pain on cross-body adduction, and pain when sleeping on that side. Often co-exists with cuff disease. Most settle with injection; persistent cases benefit from arthroscopic AC joint excision.
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Calcific tendinitis
Calcium hydroxyapatite deposit within the rotator cuff tendon, producing acute episodes of severe shoulder pain — often disproportionate to imaging findings. Most settle with image-guided barbotage or arthroscopic excision in the minority that don't.
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Cuff arthropathy
Advanced rotator cuff failure with secondary glenohumeral arthritis — characteristically with the humeral head migrated upward against the acromion. Treatment is typically reverse shoulder arthroplasty, which restores function despite the absent cuff.
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SLAP and biceps pathology
Tear of the superior labrum or inflammation of the long head of biceps. Anterior shoulder pain, often with clicking on overhead activity. Common in throwing athletes and after old shoulder injury. Treatment depends on age and tear pattern — biceps tenodesis is the workhorse.
The threshold for referral
Most shoulder pain is initially managed in primary care — GP, physiotherapy and time settle the majority. Specialist referral is appropriate when:
- Pain has not settled after 6–8 weeks of structured physiotherapy.
- The pain wakes you at night or stops you sleeping on that side.
- You cannot lift the arm overhead, or weakness is progressing.
- The shoulder gave way, dislocated, or has dislocated repeatedly.
- An ultrasound has shown a full-thickness rotator cuff tear.
- X-ray shows established glenohumeral arthritis.
- The pain followed a fall or significant injury and has not improved.
Acute injury — fall on outstretched arm, sudden weakness, a dislocation or suspected fracture — is best seen early. The practice triages urgent referrals within a week. See the shoulder injury page for the post-trauma pathway.
How a shoulder consult works
The first consult takes 30–40 minutes. It runs through a structured history (when, what made it worse, where exactly, what makes it better), a focused examination of the cuff, capsule, AC joint, biceps and glenohumeral joint, and a review of any imaging you bring. The consult ends with a diagnosis (or a clear plan to confirm it) and an itemised treatment plan — physiotherapy, injection, further imaging, or surgery — written for the GP.
Hand and physiotherapy are coordinated on-site through Ruby Doolan's practice (Extend Rehabilitation), which keeps post-consult, post-injection and post-operative therapy in one place. The fees, Medicare rebates and quote process are on the fees page; GPs can find the referral pathway and urgency triage on the referrer page.
Across Central Queensland
Patients are seen for shoulder pain from Rockhampton and the wider region. Drive time and scheduling notes are on each catchment page:
Patient questions we hear most
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How do I know if my shoulder pain needs surgery?
Most shoulder pain doesn't need surgery — even severe pain. The decision depends on the diagnosis, not the severity of the pain. Cuff tendinopathy, bursitis, AC joint arthritis and frozen shoulder usually settle with non-operative treatment. Full-thickness cuff tears, persistent instability and end-stage arthritis are the conditions where surgery is more often the right answer. The first job at consult is establishing which one is driving the pain — that's what determines the pathway.
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Should I see my GP first or come straight to a specialist?
GP referral is needed for a Medicare rebate, so the GP visit comes first regardless. The GP can also organise initial imaging (ultrasound and X-ray) which is useful at the first specialist consult. Acute trauma — a fall on an outstretched arm, a dislocation, sudden weakness after lifting — is best seen sooner, and most GPs will refer urgently in that situation. Slow-onset pain that has not settled with 4–6 weeks of physio is the typical specialist referral.
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What imaging do I need before the consult?
Plain X-ray of the shoulder (AP, axillary and outlet views) is the baseline. Ultrasound is useful for soft-tissue structures (cuff, biceps, bursa) and is the next step in most cases. MRI is reserved for cases where arthroscopy or shoulder replacement is being considered. The consult uses whatever imaging exists; further imaging is arranged from the consult if needed. Bringing the films (or a link to the radiology portal) is more useful than the report alone.
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Why does shoulder pain hurt so much at night?
When you lie down the inflamed structures of the shoulder lose the gravity-assisted offload they get during the day, and the lying position compresses the cuff and bursa under the acromion. Night pain is a hallmark of cuff disease, frozen shoulder and AC joint arthritis. Sleeping with the affected arm supported on a pillow, semi-upright, often helps — and persistent night pain that wakes you is itself a reason to see a specialist.
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Does cortisone fix the problem?
A corticosteroid injection settles inflammation, which is often what is driving the pain — but it does not repair a torn tendon, regrow worn cartilage or release a contracted capsule. Injection is part of treatment, not the whole treatment. Used at the right time it gives a window of pain relief that lets physiotherapy be effective. Used too often it weakens tendon. The consult is where this trade-off is set out for the specific diagnosis.
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How is the cause of shoulder pain identified?
History does most of the work — when did it start, what made it worse, where exactly does it hurt, what makes it better. Examination provokes the structures suspected from the history (specific tests for cuff, biceps, AC joint, instability, capsule). Imaging confirms or refines the diagnosis. Most shoulder problems are diagnosed in clinic; the imaging is supportive. Where there is genuine diagnostic uncertainty, an injection of local anaesthetic into a specific structure can clarify which one is hurting.
Speak to the practice
about your shoulder
Most patients are referred by their GP. Bring the referral and any imaging you have already had — the practice handles the rest.
