Decision-making in musculoskeletal health care is a complex process, and therefore disagreement concerning the ideal treatment pathway is not unexpected.1 Clinicians striving to provide evidence-based patient care have multiple subjective factors to consider, and these multiple factors complicate decision-making. To date, there has been a focus on specialist referral for musculoskeletal injuries, including shoulder lesions, leading to expensive testing and – potentially – unnecessary treatment.2-4Decision-making for shoulder treatment pathways has received little attention in the literature, and the key clinical factors on which decision-making is based remain unclear. This report will consider the difficulties associated with musculoskeletal decision-making and present a possible solution to improve clinical decisions based on multi-criteria decision-making , using shoulder injuries as a model.