Chronic Shoulder Pain:Part I. Evaluation and Diagnosis
University of Massachusetts, Fitchburg, Massachusetts
University of Connecticut, Hartford, Connecticut
Shoulder pain is defned as chronic when it has been present or longer than six months. Common conditions thatcan result in chronic shoulder pain include rotator cu disorders, adhesive capsulitis, shoulder instability, and shoul-der arthritis. Rotator cu disorders include tendinopathy, partial tears, and complete tears. A clinical decision rulethat is helpul in the diagnosis o rotator cu tears includes pain with overhead activity, weakness on empty canand external rotation tests, and a positive impingement sign. Adhesive capsulitis can be associated with diabetesand thyroid disorders. Clinical presentation includes diuse shoulder pain with restricted passive range o motionon examination. Acromioclavicular osteoarthritis presents with superior shoulder pain, acromioclavicular joint ten-derness, and a painul cross-body adduction test. In patients who areolder than 50 years, glenohumeral osteoarthritis usually presents asgradual pain and loss o motion. In patients younger than 40 years,glenohumeral instability generally presents with a history o dislo-cation or subluxation events. Positive apprehension and relocationare consistent with the diagnosis. Imaging studies, indicated whendiagnosis remains unclear or management would be altered, includeplain radiographs, magnetic resonance imaging, ultrasonography,and computed tomography scans. Plain radiographs may help diag-nose massive rotator cu tears, shoulder instability, and shoulderarthritis. Magnetic resonance imaging and ultrasonography are pre-erred or rotator cu disorders. For shoulder instability, magneticresonance imaging arthrogram is preerred over magnetic resonanceimaging. (
Am Fam Physician.
2008;77(4):453-460. Copyright © 2008American Academy o Family Physicians.)
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