Get a printable copy pdf file of the complete article 157k, or click on a page image below to browse page by page. Visceral referred pain to the shoulder an important component of the initial orthopedic evaluation is the differentiation of the causes of the patients pain complaints between a musculoskeletal origin and a visceral pathologic condition or disease. Shoulder pain, diagnosis, rehabilitation treatment. To conduct a literature search to identify medical conditions that may mimic fm and have highlighted features that may differentiate these various conditions from fm. Clinical tests appear unable to clearly identify the structures that generated pain and interpretation of diagnostic imaging. Shoulder pain is defined as chronic when it has been present for longer than six months. The case report highlights the importance of differentiating shoulder pain that is from the shoulder from cervical referred pain, despite many factors suggesting the opposite. Pdf differential diagnosis of shoulder and cervical pain. Positive sign is pain in the arc between 70120 hawkins impingement test. Cervical spine injury eg, posttraumatic fracture or. Although rare, the clinician should include entrapment of the supraclavicular nerve within the clavicle in their differential diagnosis of shoulder pain. Then rotate shoulder internally bringing the arm across the front of the pt. The presentation of sensory and muscular deficits is variable.
Cervical lymphadenopathy due to infection or cancer. Neck pain cervicalgia and torticollis doctor patient. Links to pubmed are also available for selected references. Table 31 outlines the typical time course associated with different diseases causing abdominal pain. From concordia university presents the walrus talks health. Further testing of chronic shoulder pain, using imaging, should be performed when the diagnosis remains unclear or the outcome would change management.
In most literature describing the differential diagnosis of anterior shoulder pain, the coracoid. Differential diagnosis of the shoulder flashcards quizlet. Full text is available as a scanned copy of the original print version. Shoulder pain, diagnosis, rehabilitation treatment, clinical framework. The differential diagnosis of chest pain bruce gao. Other causes of neck pain and muscle spasm include. In clinical practice, the assessment of a patient with sp is. N eck and shoulder pain are common presenting symptoms in the general adult population with a 41. However, epidemiologic calculations can vary depending upon how sis is defined. Shoulder pain differential diagnosis orthopaedicsone articles. Pdf on aug 1, 2002, j herbert stevenson and others published evaluation.
Patients often come to our office with shoulder pain. In differential diagnosis in physical therapy, ed 2, philadelphia, 1995, saunders. The search strategy included the terms shoulder pain, rotator cuff disorder. A headache is a pain that occurs in head and neck region. Abdul basit is a final year medical student at bolan university of medical and health sciences, quetta, balochistan. Atraumatic shoulder pain for the primary care physician. Diagnosis of these conditions is mostly clinical and radiological investigation supports the diagnosis, with the management depending on the etiology. Pain experienced in the shoulder, upper, and lower arm can be as a result of a myriad of medical conditions, 1 including mechanical pain from nearby musculoskeletal structures such as the shoulder or the cervical spine, 2 4 or from regional structures such as the thoracic spine and brachial plexus. Costovertebral cv and costotransverse ct joint hypomobility and active trigger points trps are possible sources of upper thoracic pain. Start studying differential diagnosis of the shoulder.
Differential diagnoses for the cervicothoracic shoulder. Apr 14, 2020 the shoulder is the most flexible joint in your body, and given the number of everyday activities its involved infrom brushing your hair to reaching up into the cupboardits easy to see why shoulder pain is something youd want to get to the bottom of right away. They may have had an injury and had a gradual onset of pain in the. Neck pain is a common complaint of patients presenting to a primary care office. Liddle, md assistant professor of orthopedics assistant professor of internal medicine. Differential diagnosis of neck pain jama jama network. Needs from to exclude dx of concomitant frozen shoulder. Differential diagnosis of shoulder pain followed by.
Screening for visceral disease is important for several reasons, including the following. Headaches are classified on primary and secondary bases. Differential diagnosis and treatment in a patient with posterior upper thoracic pain background and purpose. Furthermore, within the consideration of lifethreatening causes, patients may be suffering from coronary causes, as well as pulmonary embolism, aortic dissection, aortic rupture, pneumothorax, or. Oct 25, 2018 rotator cuff injuries are a common cause of shoulder pain in people of all age groups. After negative findings, the patient returned for continued treatment of right medial epicondylitis. This may not be the complete list of references from this article. Physical therapy history, examination, and differential diagnosis led to red flag identification and a referral back to the orthopedic surgeon for diagnostic imaging. Other conditions which can give rise to acute shoulder pain are impingement syndrome, frozen shoulder, and bursitis. Overhead work or play tennis, pitching pain rolling on shoulder in bed night pain. In children acute neck pain is usually due to an infectious process in the nasopharynx, the central nervous system, or the lymph nodes. Visceral referred pain to the shoulder chirocredit.
A 44yearold male was referred with a diagnosis of shoulder impingement syndrome. Differential diagnosis of lesions at the heel and ankle. Shoulder dislocations are more common in teens to the fourth decade. Chronic widespread pain is, however, not pathognomonic of fm, and other conditions may present similarly with cwp, requiring consideration of a differential diagnosis. Impingement tendinopathy, bursitis, pasta age usually 3555. Approximately 10% to 15% of the worlds population suffer from an episode of neck pain at any time and 40% of the population will suffer from neck pain over a 12month period. Differential diagnosis of shoulder and cervical pain. Each of the three questions for differential diagnosis was addressed, and clinical tests and examination findings were used to differentiate the origin of the patient s symptoms. Pdf on feb 21, 2015, nihal ozaras and others published differential diagnosis in upper back pain find, read and cite all the research you need on researchgate. They represent a spectrum of disease, ranging from acute reversible tendinitis to massive tears involving the supraspinatus, infraspinatus, and subscapularis. Shoulder impingement syndrome differential diagnoses. Painful shoulder motion with subdeltoid and subacromial bursitis, especially with abduction and extension.
Acute shoulder pain online family medicine course lecturio. Diagnosis should be pragmatic and based on a clinical assessment box 1 that. Differential diagnosis of recurrent abdominal pain. Shoulder pain is highly prevalent within the general population, second only to lower back pain. May 15, 2000 shoulder pain is a common complaint in family practice patients. Shoulder pain differential diagnosis orthopaedicsone. Burbank et al, chronic shoulder pain part i, am fam physician 2008 3. Studies suggest that shoulder impingement syndrome sis is the most common cause of shoulder pain, accounting for approximately 30 to 35 percent of shoulder disorders. Clinical presentation includes diffuse shoulder pain with restricted passive range.
Oct 23, 2018 in 1972, neer first introduced the concept of rotator cuff impingement to the literature, stating that it results from mechanical impingement of the rotator cuff tendon beneath the anteroinferior portion of the acromion, especially when the shoulder is placed in the forwardflexed and internally rotated position. Shoulder pain can be due to osteoarthritis, muscle tears, tendonitis, and. The unique anatomy and range of motion of the glenohumeral joint can present a diagnostic challenge, but a proper clinical. Differential diagnosis headache made easy with mnemonics. Differential diagnosis of lesions at the heel and ankle disorder diagnosis treatment posterior pain achilles tendinitis pain during rising on tiptoe differentiate 4 types by palpating insertion, localizing sign and passive plantiflexion deep transverse friction alternative. It also supports the clinical utility of the mckenzie assessment as one approach in making this differential diagnosis. Rotator cuff injuries are a common cause of shoulder pain in people of all age groups. Pain with speeds resisted shoulder flexion with wrist supinated and elbow extended and yergasons. In the differential diagnosis of neck pain, consideration may be taken of the patients age, the manner of onset and the duration of the pain, the severity of the pain, and the general condition of the patient. Rotator cuff rc tendinopathy refers to pain and weakness, most commonly. The free encyclopedia a differential diagnosis is the distinguishing of a particular disease or condition from others that present similar symptoms. A clinical decision rule that is helpful in the diagnosis of rotator cuff tears. Shoulder pain is a common complaint in family practice patients. Pain is gradual and can develop over a few weeks or months.
Therefore, the differential diagnosis of abdominal pain can be organized based on whether patients are presenting with their first episode of acute abdominal pain, a recurrent episode of acute abdominal pain, or chronicsubacute abdominal pain. Towards an integrated clinical framework for patient with shoulder pain. The differential diagnosis of chest pain syndrome is broad and disparate, including disease processes that range from nonurgent to life threatening. First, we categorize the differential diagnosis of rap both by its prevalence of etiologies at different ages and by three clinical patterns. Some are fatal or lifethreatening and some are harmless. Diagnosis of acute onset of shoulder pain with accompanying muscular weakness can be challenging.
Determining the source of a patients pain in the upper thoracic region can be difficult. Arm pain, cervical radiculopathy, differential diagnosis, shoulder. Upon a second physical therapy evaluation, symptoms progressed and functional capabilities. Full text full text is available as a scanned copy of the original print version. Differential diagnosis of rotator cuff, frozen shoulder. Differential diagnosis of common shoulder pain article pdf available in journal of the korean medical association 578. How to selfdiagnose your shoulder pain breaking muscle. Common shoulder problems share overlapping clinical features. Bruce gao, a shad fellow and firstyear medical student at the university of calgary, cofounded. Burbank et al, chronic shoulder pain part i, am fam physician 2008 4. Shoulder painis it from the shoulder, neck, or both.
Pain with speeds resisted shoulder flexion with wrist supinated and elbow extended. Compromised shoulder movement due to pain, stiffness, or weakness can cause substantial disability and affect a persons ability to carry out daily activities eating, dressing, personal hygiene and work. Dr lewis developed the shoulder symptom modification procedure and the shoulder fixation belt seen in figure 6. Position the shoulder at 90 of abduction and elbow at 90 of flexion. It may be a migraine sharp or throbbing pain, tensiontype headaches and cluster headaches. Shoulder bursitis shoulder pain differential diagnosis. Interrupted sleep with an increase in pain with rolling onto the affected shoulder. Differential diagnoses for the cervicothoracic shoulder region pain with disc test. Parsonageturner syndrome, although relatively uncommon, should be considered in the differential diagnosis of acute onset of shoulder pain and weakness. Symptoms of coracoid impingement syndrome include anterior shoulder pain, occasionally radiating down to the upper armforearm. Case report differential diagnosis of shoulder and cervical.
1444 11 280 1076 988 1449 1504 168 142 192 746 1020 113 714 1499 284 573 230 846 1137 125 581 1262 1392 1111 697 978 458 1128 1167 1003 314 533 1198