Symptom Finder - Shoulder Pain
Shoulder Pain
If there is no obvious deformity, the first thing to do with a patient who presents with shoulder pain is to palpate the subacromial bursa, the biceps tendons, and the glenohumeral and acromioclavicular joints. Then it is necessary to test active and passive abduction of the shoulder joint. If the patient has limited active abduction, but the physician can get full or almost full abduction of the joint, the patient very likely has a subacromial bursitis or impingement syndrome. If there is both active and passive limitation of abduction of the joint, the patient has some form of arthritis (e.g., gout, osteoarthritis) unless the shoulder pain is acute, in which case a fracture or dislocation must be considered. A frozen shoulder or adhesive capsulitis must also be considered as well as sympathetic dystrophy. In these cases, it is necessary to look for possible lung or cardiovascular pathology as well. If there is tenderness of the biceps tendon, one should confirm the presence of tenosynovitis of the long head of the biceps by having the patient flex the biceps against resistance. Finally, it is necessary to inject the bursa, joint, around a tendon, or
maybe a trigger point in the shoulder with 1% lidocaine to confirm the diagnosis. Remember, pain in the shoulder can be referred from a
cholecystitis, subphrenic abscess, or other systemic pathology.
If there is no obvious deformity, the first thing to do with a patient who presents with shoulder pain is to palpate the subacromial bursa, the biceps tendons, and the glenohumeral and acromioclavicular joints. Then it is necessary to test active and passive abduction of the shoulder joint. If the patient has limited active abduction, but the physician can get full or almost full abduction of the joint, the patient very likely has a subacromial bursitis or impingement syndrome. If there is both active and passive limitation of abduction of the joint, the patient has some form of arthritis (e.g., gout, osteoarthritis) unless the shoulder pain is acute, in which case a fracture or dislocation must be considered. A frozen shoulder or adhesive capsulitis must also be considered as well as sympathetic dystrophy. In these cases, it is necessary to look for possible lung or cardiovascular pathology as well. If there is tenderness of the biceps tendon, one should confirm the presence of tenosynovitis of the long head of the biceps by having the patient flex the biceps against resistance. Finally, it is necessary to inject the bursa, joint, around a tendon, or
maybe a trigger point in the shoulder with 1% lidocaine to confirm the diagnosis. Remember, pain in the shoulder can be referred from a
cholecystitis, subphrenic abscess, or other systemic pathology.