Margit Kooijman

14 Netherlands, in 2012, 11% of the registered sick leave days were due to CANS 11 . Yearly costs of CANS are estimated at 2.1 billion Euros of which most costs are due to sick leave and 150 million due to health care usage 12 . As far as the author is aware, no estimates of costs of shoulder pain specifically are known. Shoulder pain: (lack of) terminology The main reason that the estimates of the occurrence of shoulder pain are so diverse is that there is no consensus on the terminology of this musculoskeletal condition 13 . A review by Van Eerd et al. (2003) revealed 27 different classification systems for upper extremity musculoskeletal disorders for the working population alone 14 . These systems varied in the criteria to describe the disorder, the labels used to identify them and in the disorders that were included. Lack of uniformity in diagnostic labeling is complicated by the weak correlation between structural factors and the clinical presentation of shoulder pain 15,16 . This phenomenon is being acknowledged throughout the spectrum of musculoskeletal disorders 17 . As the categorizations of these pathological processes are poorly understood, the cataloging of pain and dysfunction stemming from the musculoskeletal system cannot be but prone to variable interpretations 18 . Receiving different diagnostic labels from different clinicians is at least confusing and at worst detrimental for patients as these diagnostic terms have implications on their perception 19 . For shoulder pain in particular, clear definitions are also hindered by the limited diagnostic value of physical examination tests. These are meant to aid clinicians in diagnosing patients presenting with shoulder pain 20 . However, a Cochrane analysis of the literature identified the existence of more than 170 different tests 21 . Moreover, some tests are known by different names or are used for several different shoulder diagnoses. This myriad of information would challenge any clinician to make any choice. A blessing in disguise, is that all meta-analyses on this subject contend that no single test was pathognomonic for any specific diagnosis 20-24 . Still, it is almost tangible that this is frustrating for patients and clinicians alike. Prognosis The increase in the prevalence of musculoskeletal diseases combined with an absence of clear underlying etiological mechanisms implies that its management is becoming increasingly reliant on information on the prognosis 2 . This trend can also be observed in studies focusing on patients with shoulder pain 19,25 . The prognosis for patients with shoulder pain is moderately favourable, as about 40-60% have recovered within six months to two years 26,27 . At six months, among Danish musculoskeletal physiotherapy patients, only one in two perceived their