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When is someone with shoulder pain not a candidate for PT?

Like many parts of the body, non- neuro-muscular-skeletal conditions can refer pain to the shoulder. These include heart, liver, stomach, pancreas, Pancoast’s tumor and spleen. 

On your first visit, we will ask you questions and perform tests to assure your shoulder symptoms are something we can treatment and your shoulder pain is not a medical emergency. Some examples of history and exam findings we would look for to determine if a patient needs to be referred to another healthcare provider include:

  • Tumor: History of cancer, unexplained weight loss, pain not correlated with mechanical stress and unexplained fatigue.
  • Infection: Red skin, fever, systemically unwell.
  • Fracture: Significant trauma, seizure, acute disabling pain, acute loss of motion, deformity/loss of normal contour
  • Neurological lesion: Unexplained sensory or motor deficit
  • Visceral pathology (such as heart, liver, stomach, pancreas, Ppancoast’s tumor and the spleen).: Pain not reproduced with shoulder mechanical stress, pain/symptoms with whole body physical exertion or respiratory stress (such as walking up stairs), pain associated with gastrointestinal symptoms and/or shoulder pain associated with the ingestion of fatty foods. 


  • Seitz, PT, PhD, DPT, OCS;, A., Christain, PT, DPT, OCS, SCS, H., Lutz, PT, DPT, PhD, A. and Shanley, PT, PhD, OCS, E., 2021. Current Concepts of Physical Therapy, 5th Edition-The Shoulder: Evidence-Informed Physical Therapy Patient Management. 5th ed. Academy of Orthopaedic Physical Therapy.

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