How a patient’s history can give vital clues when diagnosing a shoulder injury

Written by: Mr Ziali Sivardeen
Published: | Updated: 29/01/2019
Edited by: Lisa Heffernan

The shoulder is a complex joint, which is sometimes difficult to assess. However, some key points in a patient’s history can really help with the diagnosis. Leading consultant orthopaedic surgeon, Mr Ziali Sivardeen, gives a few useful pointers that a specialist will consider when investigating a shoulder injury.


Certain conditions are more common in different age groups. For example, younger patients will more commonly experience instability problems including a labral tear or a biceps lesion, whilst older patients more commonly have a rotator cuff tear or arthritis.

Job or sports and hobbies

A desk job, or job at a computer desk can often be associated with poor posture. This poor posture may lead to a muscle imbalance, and various problems around the shoulder including subacromial impingement. This group of patients often do very well with physiotherapy working on the posture, cervical spine, shoulder, and scapula.

Sports people are more prone to certain types of injury due to the repetitive nature of training and the sport itself. For example, tennis players are more prone to SLAP lesions, and cyclists often have AC joint problems.

Where is the pain and where does it go?

Pain that goes below the elbow is often from the neck and not the shoulder.

Night pain

Pain during the night normally indicates the severity of the problem, but it could also be linked to something more sinister going on, like cardiac ischaemia, metastatic disease, lung tumour, pneumonia or peptic ulcer disease.

This risk of other conditions causing pain during the night is why it is really important to get an injury checked by a specialist.


Diabetic patients, or patients with Dupuytren’s contracture are more prone to having a frozen shoulder/adhesive capsulitis. This is helpful, because if you diagnose this, it guides you on a pathway away from immediate surgery in many cases.

Severe traumatic injury

Has the patient had a traumatic injury to the shoulder in the past? Have they had a dislocation or a big injury that may have caused problems for a couple of weeks, many years ago?

This is a useful question, because what the patient presents with now may be linked to the old injury, and it is this old injury that needs to be addressed not the new problem.

If you’ve recently experienced an injury to your shoulder, or you’re experiencing pain that won’t go away, book a consultation with Mr Sivardeen today.

By Mr Ziali Sivardeen
Orthopaedic surgery

Mr Ziali Sivardeen is a leading specialist orthopaedic surgeon, based in London. He had the honour of being the surgeon that operated on all Olympians and Paralympians requiring shoulder or elbow surgery during the 2012 London Olympic Games. Due to his role, Mr Sivardeen was invited to a special reception in Buckingham Palace.

He has worked closely with many athletes, including those linked with Premier League football clubs, where he treats knee problems such as ACL injuries, cartilage, and meniscal tears. 

Mr Sivardeen has represented the prestigious Royal Colleges of Surgeons, firstly as a tutor from 2010-2014, before being appointed as one of two regional surgical advisors for London. In 2015, he organised the pan-London Sports and Exercise Medicine Teaching Programme, and became an examiner for the Intercollegiate Fellowship of the Royal Colleges of Surgeons (FRCS exams). He was a member of the Specialist Training Committee for sports and exercise medicine trainees in London from 2009 to 2015, so played an important part helping to develop this new speciality.

His research interests include orthopaedic shoulder and knee problems, including sports injuries in elite rugby players. He had in excess of 70 presentations accepted at prestigious national and international meetings by 2012. At the main World Shoulder and Elbow Meeting in 2010, his research was the only piece from the UK that was short-listed for the best prize and he was invited to give an educational talk at the next World Shoulder and Elbow Meeting (ISCES) held in Japan in 2013.

He is one of the few (perhaps only) consultant orthopaedic surgeons in the UK to be trained by 3 presidents of national orthopaedic societies at fellowship level. He has a passion for teaching and training, and regularly runs sports injury symposia in London. He has also been invited around the world to deliver lectures and master classes teaching other surgeons, consultants and practitioners.

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