BACKGROUND Shoulder pain is a common presentation in general practice. Data on prognosis, treatment and compliance for acute shoulder pain are lacking but would be valuable for guiding decision making. This study collected data on acute shoulder pain and its outcome over 6 months. METHODS A prospective observational study of 100 acute shoulder pain patients from 21 general practices in southeast Queensland. RESULTS Disability levels at presentation were the best predictor of outcome at 6 months. Patients who had not fully recovered at 6 months had higher risk of depression at presentation. The biggest improvements in pain and disability scores occurred in the first month of management, with almost 60% of patients fully recovered at 6 months. Over 40% of patients had at least one radiological investigation for their pain. DISCUSSION Measuring disability, pain and mood levels in acute shoulder pain patients gives the best prognostic data. The use of radiological investigations may be higher than is clinically necessary. Early multimodal management of acute shoulder pain patients needs consideration.