A positive shoulder test and a changed history

A patient with shoulder pain has a positive provocative maneuver that resembles a common rotator-cuff presentation. During the history, the patient also reports progressive hand weakness, new sensory symptoms and unremitting pain different from the earlier mechanical discomfort. A learner proposes treating the familiar shoulder label without further review because the test is positive. The practitioner recognizes that the test is not perfectly specific and that symptoms may have more than one cause. The patient’s function, neurological findings, time course and relevant systemic history need attention. The next plan should identify whether urgent referral or additional qualified investigation is required rather than using an exercise response as a diagnostic experiment while the neurological symptoms progress.