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Intodution
Shoulder pain is the third-leading cause for patients to see
musculoskeletal care. The impact of shoulder pain on health-related
quality of life is also substantial. It is important to obtain the history,
physical examination and relevant investigation, which are essential for
reaching the diagnosis. For many disease entities, a diagnosis can be
accurately reached even without the use of imaging studies. In this
chapter an overview of common causes of shoulder pain and basic
clinical approach to diagnosis are discussed.
Classification
The causes for shoulder pain can be classified as follows:
A. Non traumatic
Intrinsic causes
1. Genohumeral
i.
Rotator cuff tendinopathy
ii.
Rotator cuff tear
iii.
Subacromian bursitis
iv.
Glenohumeral arthritis
v.
Labral rear
2. Extra glenohumeral
i.
Bicipital tendinopathy
ii.
Acromioclavicular arthritis
iii.
Subscapular bursitis
iv.
Distal clavicle osteolysis
Extrinsic causes
1.
2.
3.
4.
5.
6.
B. Traumatic
- Fracture clavicle
- Fracture humerus
- Glenohumeral dislocation
- Acromioclavicular ligament sprain
History the first step in diagnosis the cause of shoulder pain is taking
thorough history. Readers can refer to chapter 2 for basic concepts on
history taking. Initially all the red flag indicators must be ruled out.
Red Flags
These include:
-
Tumor
Acute rotator
Unreduced dislocation
Infection
Unexplained significant sensory ad motor deficit
Pulmonary or vascular compromise
Investigation
Diagnostic imaging of the shoulder may be valuable when directed by
the history and physical examination. A variety of modalities may be
employed.
Plain fotograph
Plain fotographs of the shoulder general have limited benefit in the
evaluation of non-traumatic shoulder pain. While there are no specific
guideline for when radiography is indicated, it is generally
recommended to obtain plain in patiens who have lost rang of motion,
particularly when there is serve pain, and after trauma. When plain film
are obtained in a patient with a history of trauma, both AP and axillary
view are warranted since some conditions can be missed on the former
alone. Plain films can identity the following:
-
Ultrasonography
In the of skilled operators, the diagnostic accuracy of ultrasound has
been found to be the equivalent of MRI in identifying rotator cuff tears,
labral tears, and biceps tendon tears and dislocations. Ultrasound is
less expensive than MRI and preferred by patient