AIM: Shoulder pain is a common cause for physiatrist's consultation equally by both men and women of all ages. Since the causes of painful shoulder syndrome are as numerous as are the types of treatment, the choice of therapy should be targeted. Before any treatment is initiated, accurate diagnosis should be established by thorough history taking and scrupulous physical examination. The degree of disability should be quantified using functional assessment scales to identify the anatomic injury underlying the pain syndrome, including diagnostic studies such as x-ray, rotator cuff ultrasonography and magnetic resonance imaging. Given the high referral rate for physical therapy, our study aimed to determine a diagnostic-therapeutic pathway that could be standardized and performed using simple, inexpensive diagnostic procedures. METHODS: We studied 50 subjects presenting with painful shoulder syndrome. Assessment included history taking and physical examination, comprising 6 instruments (Yocum, Jobe, impingement test, Yergason, palm up and Aply). Functional assessment was performed using the Constant-Murley scale (1987); diagnostic imaging studies comprised x-ray and ultrasonography of the rotator cuff. The patients were randomly divided into 4 groups: the 1st received functional rehabilitation, and the 3 other groups received functional rehabilitation associated with physical therapy (radar, diadynamic current, ultrasonography). Longitudinal evaluation was planned as T0 (pretreatment-baseline), T1 (at 5 days), T2 (at 10 days), T3 (at 30 days after end of treatment). A physical examination was performed at each time point using the diagnostic imaging procedures mentioned above, plus assessment on the Constant-Murley scale. RESULTS: The results indicate the importance of physical examination that can pinpoint the injury to the anatomic structure in establishing a correct diagnosis of painful shoulder syndrome. Diagnostic imaging studies offer a wealth of information and confirm the findings of the physical examination. CONCLUSION: All patients experienced improvement with treatment, but the association of physical therapy and functional rehabilitation did not seem to lead to added benefit for the patient.

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