Shoulder Pain

 

a) Shoulder pain is a common complaint we see in clinic, and it is crucial to determine if it is a manifestation of systemic disease

 

b) Because the shoulder joint is so lax, with a shallow glenoid fossa and small articulating surface, it is susceptible to injury

 

c) Etiologies:

      - Traumatic: fracture, dislocation, subluxation, AC-joint separation

      - Intrinsic:

         - Glenohumoral: impingement, rotator cuff tear, labral tear, adhesive capsulitis, glenohumoral arthritis/subluxation

         - Extra-GH joint: biceps tendonopathy, subacromial bursitis, acromioclavicular arthritis

      - Extrinsic:

         - Neurologic: cervical stenosis, brachial plexopathy, peripheral nerve entrapment

         - Abdominal: diaphramgatic irritation, hepatobiliary disease

         - Cardiac: myocardial ischemia

         - Thoracic: upper lobe pneumonia, apical tumor

 

d) Key to differentiating between the three lies in history and physical:

      - Extrinsic shoulder pain tends to be vague and difficult to localize

      - Intrinsic:

         - Extra-GH joint pain localizes to affected structure

         - GH pain typically anterolateral

            - Pain on active motion suggests muscle or tendon pathology (rotator cuff)

            - Pain on passive motion suggests joint pathology (arthritis, adhesive capsulitis)

 

e) It is important to review all aspects of the study. In this case, on the shoulder x-ray, the joint was normal, but a hilar mass was missed.

 

 

(Christopher Woo MD, 8/27/10)