Shoulder Pain

D. Monte Hunter

Func.tjon.al..Anatomy Bones „and. Joints

Muscles

Bursae

CoracoacromiaLA"

Impingement. Syndrome Pathophysiology

Clinical.Features

Emergency. .Department ..Treatment Follow-up

Subacromial.Bursitis Pathophysiology

C.lMic.aLFe.at.ures Radiographic .Eindings Emergency. .Department ..Treatment

Follow-up

Rotator.Cuff ..Tendinitis Pathophysiology

CHmcal.F.eatures

Radiographic. .Findings

Emergency. .Department, ..Treatment

Follow-up

RptatorCMff ..Tears Pathophysiology

Radiographic .Findings Emergency. .Department ..Care Follow-up CalcificTendinitis

.Pathophysiology Clinical.Features

Radiographic. .Findings Emergency. .Department ..Treatment Follow-up

Adhesive ..Capsulitis Pathophysiology

Clinical.Features

Radiographic. Findings

Emergency. .Department ..Treatment Follow-up

Disorders.. of.t.h.e. .BicepsTendon .Pathophysiology

Clinical.Features

Emergency. .Department ..Treatment Follow-up

Osteoarthritis DifferentialDiagnosis

The..Neck

The.Brachia.LPlexus vas.culaLIniu.ries Neurologiclniury ThoracicOutlet .Syndrome Pancoast's.. Tumor ThPLas.o„-Ab.d.omi^.aLD.isoLde^s

Bibliography

Shoulder pain is one of the most common musculoskeletal complaints of patients over age 40. Work, recreation, and normal daily activities all place great demands on the shoulder. Of all adult patients presenting for evaluation of shoulder pain, one-third related their pain to work, one-third related their pain to athletic activity, and one-third could not identify any one specific precipitating event or factor.

Injuries involving the rotator cuff are the most common cause of shoulder pain. While these injuries can be acute, they more commonly occur from chronic overuse. Overuse can produce pathologic changes in the rotator cuff structures that progress along the continuum starting with subacromial bursitis from mechanical irritation, progressing to rotator cuff tendinitis, and eventually leading to partial and full thickness rotator cuff tears. Laborers who work with their arms above the horizontal and athletes of all ages, especially throwers, swimmers, and racquet sports enthusiasts, are the most susceptible to chronic overuse injuries. Acute injuries to the rotator cuff usually require significant trauma such as extreme forced hyperabduction or hyperextension of the upper extremity.

While disorders of the rotator cuff are the most common cause of shoulder pain, conditions affecting other intrinsic structures of the shoulder complex also can cause pain. Additionally, extrinsic disorders can refer pain to the shoulder and must be considered in the differential diagnosis. A focused history and physical examination carried out with an understanding of the complex anatomy and function of the shoulder are essential in determining the source of shoulder pain. Establishing the proper diagnosis, initiating the appropriate treatment, and making timely referrals for follow-up are critical in preserving the function and mobility of the shoulder.

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