Shoulder Pain

Aka: Shoulder Pain, Shoulder Injury

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II. Causes: Acute Musculoskeletal or Glenohumeral Causes of Shoulder Pain

  1. Fracture
    1. Clavicle Fracture
    2. Scapula Fracture
    3. Humeral Fracture
  2. Glenohumeral Conditions
    1. Septic Arthritis of the Shoulder must be considered in all cases of acute Shoulder Pain
    2. Superior Labrum Anterior to Posterior Tear (SLAP Lesion, Labral Tear)
    3. Shoulder Dislocation
  3. Non-Glenohumeral Conditions
    1. Diffuse Shoulder strain
    2. Acromioclavicular joint separation
    3. Sternoclavicular Dislocation
    4. Biceps Tendinopathy
    5. Tear of long head of biceps
  4. Vascular
    1. Effort Thrombosis

III. Causes: Chronic Musculoskeletal Causes of Shoulder Pain

  1. Glenohumeral overuse or injury
    1. Shoulder Impingement Syndrome
    2. Rotator Cuff Tear
    3. Adhesive Capsulitis
  2. Shoulder Degenerative Joint Disease
    1. See Rheumatologic Conditions Affecting the Shoulder
    2. Acromioclavicular joint Arthritis
    3. Glenohumeral joint Arthritis
  3. Shoulder Instability
    1. Shoulder Subluxation
    2. Recurrent Anterior Shoulder Dislocation
    3. Recurrent Posterior Shoulder Dislocation
  4. Other conditions
    1. Biceps Tendonitis

IV. Causes: Neuropathic Shoulder Pain

  1. Shoulder-Band Syndrome
  2. Herpes Zoster (Shingles)
  3. Brachial Plexus Burner or Stinger
  4. Brachial Neuritis
  5. Carpal Tunnel
    1. Commonly causes Shoulder Pain (in addition to wrist)
  6. Cervical Disc Syndrome
    1. Cervical Radiculopathy, typically at C5-6 radiates to the Shoulder

V. Causes: Abdominal Source of Referred Shoulder Pain

  1. Referred pain from phrenic nerve (diaphragm) radiation sites
    1. Cutaneous fourth cervical Nerve (top of Shoulder)
    2. Innervates top of Shoulder
    3. Supraspinous fossa
    4. Over acromion or clavicle
  2. Etiologies
    1. Abdominal Trauma
      1. Ruptured Spleen
      2. Liver, Pancreas or Kidney injury
    2. Gastric Ulcer or Duodenal Ulcer perforation
    3. Subphrenic abscess
    4. Diaphragmatic Pleurisy
    5. Acute Pancreatitis
    6. Gallstones
    7. Appendicitis with peritonitis
    8. Liver Abscess
    9. Fitz-Hugh-Curtis Syndrome (Perihepatic inflammation)

VI. Causes: Thoracic Source of Referred Shoulder Pain

  1. Cardiac (e.g. Pericarditis, Myocardial Infarction)
    1. Left arm, or Shoulder
    2. Neck, lower jaw, and interscapular
  2. Pulmonary (Carcinoma, Pneumonia, or abscess)
    1. Pancoast (Apical Tumor of superior sulcus lung)
  3. Hiatal Hernia
  4. Other mediastinal, aorta, esophageal causes

VII. Causes: Malignant Sources of Referred Shoulder Pain

  1. Thyroid Cancer
  2. Breast Cancer
  3. Lung Cancer
  4. Renal Cancer
  5. Hodgkin's Lymphoma
  6. Prostate Cancer
  7. Bone Metastases (Multiple Myeloma most common)
    1. Shoulder metastases (less common)
    2. Ribs, spine, and Pelvis (more common)
    3. XRay and bone scans have high False Negative Rate
  8. Paget's Disease
    1. Periosteal Bone Formation
      1. Results in cranial or spinal impingement
    2. Usually minimal or no symptoms
    3. Increased pain
      1. Think Sarcomatous degeneration

VIII. References

  1. Simon (2023) Am Fam Physician 107(5): 503-12 [PubMed]

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