A four-category diagnostic framework for shoulder presentations
This page presents a four-category diagnostic framework for shoulder presentations, developed to support clinical reasoning, classification, and decision-making across primary, advanced and specialist musculoskeletal practice.
The Four Diagnostic Categories
Rather than focusing on individual pathologies in isolation, this framework organises shoulder presentations into four clinically meaningful categories: Not the Shoulder, Unstable, Weak, and Stiff - recognising that patients may move between categories and may present with overlapping features.
How the Classification Framework is Used
The Shoulder Classification Framework was developed by Dr Angela Cadogan and Professor Jeremy Lewis and is intended as a practical, evidence-informed approach to shoulder diagnosis. It provides a shared diagnostic language that supports assessment, investigation planning, referral decisions, and rehabilitation strategy selection, while acknowledging the complexity and variability of real-world clinical presentations.
Download the Shoulder Classification Framework
A one-page clinical reference for shoulder diagnosis and classification.
Further Learning and Clinical Application
Clinicians interested in a more detailed exploration of how this framework is applied in practice, including common diagnostic pitfalls, overlap presentations, and clinical case examples, can access further educational resources linked below.
Published version of the Shoulder Classification Framework:
Cadogan A, Lewis J, Hollis D. Assessing and classifying musculoskeletal shoulder conditions. In: Fernandez-de-las-Penas C, Lewis J, editors. The Shoulder: Theory and Practice: Handspring Publishing Limited; 2022. p. 217-30.
Cadogan A, Lewis J, Hollis D. Assessing and classifying musculoskeletal shoulder conditions. In: Fernandez-de-las-Penas C, Lewis J, editors. The Shoulder: Theory and Practice: Handspring Publishing Limited; 2022. p. 217-30.
Diagnostic Research:
Research examining diagnostic accuracy, classification, and clinical reasoning for shoulder pain in primary and specialist musculoskeletal practice. View diagnostic research.
Research examining diagnostic accuracy, classification, and clinical reasoning for shoulder pain in primary and specialist musculoskeletal practice. View diagnostic research.
Diagnostic Education & Training:
Structured educational programmes focused on diagnostic reasoning, classification, and decision-making for shoulder presentations. Explore diagnostic education.
Structured educational programmes focused on diagnostic reasoning, classification, and decision-making for shoulder presentations. Explore diagnostic education.
Shoulder Academy:
Advanced, case-based education exploring the clinical application of shoulder diagnosis, classification, and management. Learn more about Shoulder Academy.
Advanced, case-based education exploring the clinical application of shoulder diagnosis, classification, and management. Learn more about Shoulder Academy.