Shoulder Pain

Aka: Shoulder Pain

1. See Also
   1. Rheumatologic Conditions Affecting the Shoulder
   2. Shoulder Anatomy
   3. Shoulder Exam
   4. Shoulder History
   5. Fall on Shoulder
2. 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. Non-Glenohumeral Conditions
      1. Diffuse Shoulder strain
      2. Acromioclavicular joint separation
      3. Tear of long head of biceps
3. 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
4. Causes: Neuropathic Shoulder Pain
   1. Shoulder-Band Syndrome
   2. Herpes Zoster (Shingles)
   3. Brachial Neuritis
   4. Carpal Tunnel
      1. Commonly causes Shoulder Pain (in addition to wrist)
   5. Cervical Disc Syndrome
5. 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)
6. 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
7. 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