Ottenheijm rpg. Ultrasound imaging for shoulder pain: is it necessary? huisarts wet 2016;59(12):551-3. The prognosis of shoulder pain is unfavourable. According to the guidelines of the dutch college of general practitioners, ultrasound imaging should be considered if pain is refractory. This review discusses the role of ultrasound in the diagnostic work-up, with a view to improving the prognosis. While general practitioners would prefer to establish a specific diagnosis, the role of ultrasound is not unequivocal – is it necessary, or should it be ordered early in the disorder or only if symptoms become chronic? although ultrasound is accurate for diagnosing specific disorders and allows a diagnosis to be established in most patients, the prognosis of patients with a first episode of shoulder pain treated on the basis of ultrasound findings does not seem to be improved after 1 year. This supports the college’s recommendation that ultrasound not be ordered in the early phase of an episode and that it should be considered only in patients with refractory pain.