Shoulder

• Shoulder pain DDx:

  • Adhesive capsulitis - frozen shoulder
  • Polymyalgia rheumatica (shoulders, neck, hips)
  • Rotator cuff pathology - impingement, tendinopathy or tear
  • Subacromial bursitis
  • Arthritis of AC joint or glenohumeral joint
  • Bicipital tendinopathy
  • Paget's disease of bone
  • Referred pain from - neck pathology, cardiac ischaemia, malignancy (e.g. pancoast's tumour), diaphragm irritation
• DDx of shoulder pain not preceded by trauma:

  • Supraspinatus tendinopathy
  • Acromioclavicular joint arthritis
  • Glenohumeral joint arthritis
• Rare but important differentials of shoulder pain:

  • Septic arthritis
  • Inflammatory arthritis
  • Malignancy e.g. osteosarcoma or bony metastasis
• Shoulder pain preceded by trauma or an acute injury may be due to:

  • Shoulder dislocation
  • Fractures e.g. proximal humerus, clavicle, or rarely the scapula
  • Rotator cuff tear
• Signs of acromioclavicular joint arthritis on exam:

  • Tenderness to palpation of the AC joint
  • Pain is worse at the extremes of shoulder abduction - from around 170 degrees onwards when the arm is overhead
  • Positive scarf test - pain caused by wrapping the arm across the chest and opposite shoulder