Shoulder Pain

 A gradual onset of pain

that progresses to a very
severe level, which is
mainly located in the right
upper quadrant of the
abdomen. Pain in the
interscapular or scapular
region may be associated
with this health condition
without compromise of
shoulder motion.
 Fever is typically present,
as well as vomiting, nausea,
or visible jaundice in some
cases.
Acute Myocardial Infarction

 Crushing, strangling, or stabbing pressure

across the chest, which also may be present
in the anterior or lateral left shoulder that
radiates to one or both arms in the T1
dermatome, neck, or jaw.
 Associated symptoms include diaphoresis,
dyspnea, weakness, palpitations, and
dizziness
Acute Viral/Idiopathic Pericarditis
 Sharp and stabbing anterior chest pain that
may radiate to the neck, back, left shoulder,
or left supraclavicular region with worsening
pain with deep inspiration, coughing, trunk
rotation or side-bending, and lying supine.
 The presentation closely mimics that of an
acute myocardial infarction with a similar
referral pattern to the left shoulder and in
the T1 dermatome.
 This condition is more common in young
males
Aneurysm
 Localized shoulder pain and neuropathic
or myopathic symptoms either with or
without functional limitations; the
distribution of symptoms depends on the
affected artery.
 Aortic and carotid artery aneurysms have
been documented to give rise to shoulder
pain.
 Secondary signs may include warmth,
redness, and swelling.
Cat-Scratch Disease
 Unilateral, painless, subacute granulomatous
lymphadenopathy
 most common in the axillary lymph nodes
but may present in the cervical or inguinal
lymph nodes.
 Constitutional symptoms such as prolonged
fever, headache, and malaise may be present.
 A slow to heal scratch may also be present
with a history of recent cat scratch within
the past several months.
Cervical Disk Herniation
 Pain in the posterior or posterolateral
aspect of the neck with or without
radicular symptoms down the arm or
through the midthoracic region.
 Aching pain, burning, numbness, or
tingling radicular pain at the
supraclavicular area (C4; Fig. A), the
anterior shoulder (C5, Fig. B),
superiorposterior shoulder into the
lateral brachium (C6, Fig. C), posterior
shoulder (C7-C8; Fig. 11-2D and E) or
the axilla (T1) also may be present.
 Location of the signs and symptoms
may be seen to correlate to the
dermatome, myotome, or sclerotome of
the nerve root or adjacent root.
 Other signs may include muscle
weakness, muscle wasting, or diminution
or loss of reflex response.
 Aggravating factors could include neck
rotation or compression.
Cervical Disk Herniation
Cervical Lymphadenitis
 A supraclavicular mass with neck pain
radiating to the shoulder.
 The presence of a draining fistula is
possible.
 Masses also may appear at other locations
including the posterior neck and the
submandibular area.
Cervical Osteoarthrosis/
Osteoarthritis
 Pain in the posterior or posterolateral aspect of the
neck, which may be related with aching pain, burning,
numbness, or tingling radicular pain at the
supraclavicular area (C4), the anterior shoulder (C5),
superior-posterior shoulder into the lateral brachium
(C6), posterior shoulder (C7), or the axilla (see Fig.A
to E).
 Location of the signs and symptoms may be seen to
correlate to the dermatome, myotome, or
sclerotome of the nerve root or adjacent root.
 Other signs may include muscle weakness, muscle
wasting, or diminution or loss of reflex response.
 This condition occurs in the older population and
usually without radicular symptoms
Cervical Epidural Abscess
 Pain in the axial or appendicular region
corresponding to the segmental level of
involvement in the cervical spine and an
elevated white cell count.
 A fever may be present in up to 50% of
cases.
 Sensorimotor signs including potential
bowel and bladder disturbances may be
present.
Coronary Artery Insufficiency
 Chest pain or tightness, but may also present
as radiating pain into the shoulder or
shoulder girdle.
 Episodes may be accompanied by anginal
type symptoms similar to myocardial
infarction, such as diaphoresis, dyspnea,
palpitations, and presyncope.
 Women are more greatly affected than men,
especially when older than 50 years,
postmenopausal on hormone replacement
therapy, and with diabetes mellitus.
Costochondritis
 Dull pain with anterior chest wall tenderness that
is frequently perceived at the anterior shoulder.
 Tenderness without swelling typically is focused
along the third, fourth, or fifth costochondral
joints with possible corresponding deeper pain at
the posterior midscapular area.
 Shoulder pain may be bilateral but is less specific.
Provocation of anterior chest pain occurs with
shoulder mobility versus shoulder pain limiting
mobility.
 Reproduction of pain is typically with shoulder
abduction, horizontal adduction, or movements
against resistance.
Ectopic Pregnancy
 Pain that extends from the superior
shoulder to the proximal brachium or
axilla, accompanied by hypotensive
symptoms including nausea, dizziness,
fainting, pallor, weak pulse, or other signs
of shock or hemorrhage.
Gaseous Distention of the Stomach

 Midepigastric abdominal pain, associated

with unilateral axilla or anterolateral
chest wall pain that is unrelated to activity
or mobility.
 Alleviating factors may involve belching
and antacids.
Hepatitis
 Tenderness and pain in the right upper
abdominal quadrant, scapular region, and
right shoulder, possibly associated with
headaches, myalgias, arthralgias, fatigue,
anorexia, nausea, jaundice, and fever
Diaphragm Injury
 Lateral neck or shoulder pain with
chest pain.
Liver Injury
 Pain in the mid epigastric region or right
upper quadrant, with referred pain to the
superior shoulder, interscapular, and
upper trapezius regions.
 Additional symptoms are right upper
quadrant tenderness and guarding, and
signs of blood loss such as shock and
hypotension.
Lung Injury
 Sharp, pleuritic pain in the axilla, shoulder,
or subscapular regions with possible
referral pain to the neck.
 Clinical findings may also include
shoulder-arm pain, Horner’s syndrome,
and neurological deficits affecting the C
and T1 nerve roots in the case of apical lung
involvement.
Spleen Injury
 Left shoulder pain associated with at least
one of the following: unilateral neck pain,
upper left abdomen pain and tenderness,
nausea, vomiting, dizziness, and syncope.
 Symptoms are worse with coughing, deep
breathing, and changes in position and
may be provoked via lying in the
Trendelenburg position
 Osteomalacia
 Diffuse, general aching and global fatigue.
 Typically affecting the axial skeleton and
lower extremities, the patient rarely may
report generalized shoulder region
discomfort.
 Symptoms should be present with the
following risk factors: advanced age, cold
geographic area, vitamin D deficiency,
gastrectomy, and intestinal malabsorption
pathology
Perihepatitis (Fitz-Hugh–Curtis
Syndrome)
 An insidious onset of general shoulder pain that
may extend into the area of the clavicle.
 The pain may progress to “sharp” in nature over
the course of a few days versus months.
 This condition presents almost exclusively in
females, with concurrent symptoms that may
include right upper quadrant pain, reports of
vague abdominal symptoms, and reproduction of
right shoulder pain with palpation of the right
upper quadrant of the abdomen.
 Aggravating movements include right side-lying,
deep breathing, or reports of shortness of breath.
Pleurisy
 A moderate aching pain focused in the chest
over the affected site.
 Associated symptoms include short rapid
breathing, coughing, dyspnea, and fever with
pain referred to the shoulder and neck
regions.
 Aggravating factors include coughing, deep
inspiration, and laughing.
 Alleviating factors include side-lying on the
affected side.
Pneumonia
 Severe shoulder pain at the tip of the
acromioclavicular joint that is associated
with chest pain, cough, sputum
production, or breathlessness.
Pulmonary Embolus
 Crushing pain that may mimic myocardial
infarction or angina-type pain. Typically, the
symptoms are substernal but may present
anywhere in the trunk including the
shoulder.
 It is associated with dyspnea, wheezing,
and a marked drop in blood pressure
Rheumatoid Arthritis of the Cervical
Spine
 An onset of transitory pain and
stiffness in the shoulder
 Long-duration stiffness is especially
prevalent in the morning.
Crohn’s Disease (Regional
Enteritis)
 Generalized aching pain in the shoulder.
 This symptom is infrequently the initial
presenting symptom but may be an
associated arthralgia during an acute
episode of Crohn’s disease.
 Other associated issues may include
erythema nodosum, fever, weight loss,
arthritis, and complications from long-
term corticosteroid use.
Psoriatic Arthritis
 An insidious onset of lumbopelvic and hip
pain associated with psoriasis.
 The severity of arthritis is uncorrelated
with the extent of skin involvement.
 Pitting nail lesions occur in 80% of
individuals with this condition.
 Dactylitis, tenosynovitis, and peripheral
arthritis also are common.
Scleroderma
 Myalgia, arthralgia, fatigue, weight loss,
limited mobility, and hardened skin about
the hands, knees, or elbows.
 This condition occurs in individuals
between 25 and 55 years of age, and is
four to five times more likely in women
than men.
 Additional symptoms may include dry
mouth and eyes, as well as Raynaud’s
phenomenon.
Systemic Lupus Erythematosus
 Lower back pain radiating to the hip and
groin pain.
 It is associated with fatigue and joint
pain/swelling affecting the hands, feet,
knees, and shoulders.
Ulcerative Colitis
 Generalized aching pain.
 This condition is infrequently the initial
presenting symptom but may be an
associated arthralgia during an acute
episode or progression of ulcerative
colitis.
 Other associated symptoms may include
fever, weight loss, arthritis, hepatobiliary
disease, and complications from long-term
corticosteroid use.
Status Post–Laparoscopic Procedure

 Moderate to severe shoulder pain that

escalates 1 to 3 days following a surgical
procedure.
Subphrenic Abscess
 Aching and persistent pain at the “tip” of
the shoulder (see Fig. 11-1).
 Further specific location may depend on
the area inferior to the diaphragm that is
affected.
 Abdominal guarding or pain will be
present.30 Patient may or may not have a
fever, recent trauma, or surgical
intervention.
Thoracic Outlet Syndrome
 Diffuse pain in the shoulder or axilla, neck,
arm, or chest.
 Symptoms may also include paresthesias,
discoloration, numbness, weakness,
nonpitting edema, and/or fatigue
Tietze’s Syndrome
 An insidious and rapid onset of dull pain with anterior chest
wall tenderness that may be perceived at the anterior
shoulder.
 An inflammatory reaction with noted swelling is present at
the second and third costochondral joints with concomitant
irritation at the chondrosternal, sternoclavicular, or
manubriosternal areas.
 Tietze’s is aggravated by a history of prolonged coughing or
overexertion.
 It is bilateral in 30% of cases.
 Provocation of anterior chest pain occurs with shoulder
mobility versus shoulder pain that limits mobility.
 Reproduction of pain is typically with shoulder abduction,
horizontal adduction, or movements against resistance
Breast Tumor
 Initial report of a nonpainful palpable firm,
irregular mass in the breast, which is the
most common presentation of breast
cancer.
 Reports of shoulder pain, deep bone pain,
and jaundice or weight loss are less
commonly seen as the initial presentation.
Gastric Ulcer
 Aching pain at the “tip” of the on the left
shoulder,42 although this symptom is rare as
an initial presentation (see Fig. 11-1).
 Pain also may be present in the interscapular
region, anterior chest, or into the facial
region.41 The onset of symptoms differs
from duodenal ulcers in that with a gastric
ulcer symptoms may coincide with when the
stomach is full rather than empty.
 The reproduction of symptoms will not be
demonstrated through range of motion in
the shoulder or scapula.
 Upper Extremity Deep Venous Thrombosis
(UEDVT; Includes Paget-Schroetter Syndrome)

 Pain in the shoulder, neck, or upper

extremity.
 Swelling, discoloration, tenderness, and
venous distention may be present.
 It may mimic a muscular strain or it
may be completely asymptomatic.
 Adhesive Capsulitis
(Frozen Shoulder)
 insidious and painful loss of both active and
passive range of motion in a capsular pattern.
 There are two types: if not associated with a
traumatic event, then it is considered
primary adhesive capsulitis; if associated with
a traumatic or surgical event, then it is
considered secondary adhesive capsulitis.
 Initial presentation mimics subacromial
impingement syndrome.
Amyloid Arthropathy
 The presence of the “shoulder pad” sign,
which is localized anterior swelling at the
shoulder.
 This sign is pathognomic for the rare
disorder of amyloidosis.
 There may be associated shoulder pain
and functional limitation with systemic
signs and symptoms of fatigue, edema, and
weight loss
Aneurysm
 localized shoulder pain and neuropathic
or myopathic symptoms either with or
without functional limitations; the
distribution of symptoms depends on the
affected artery.
 Axillary and subclavian artery aneurysms
have been documented to give rise to
shoulder pain.
 Secondary signs may include warmth,
redness, and swelling.
Ankylosing Spondylitis
 Insidious onset of shoulder pain
associated with a slowly progressive and
significant loss of general spinal mobility.
 Low back symptoms may be worse in the
morning and improve with light exercise.
 Avascular Necrosis of the
Humeral Head
 Limited motion at the glenohumeral joint, deep joint pain,
and increasing pain with motion and time of weight bearing.
 Such symptoms should lead to suspicion of osteonecrosis.
 Reports of difficulty sleeping and pain at rest are common.
 Patients are typically asymptomatic at the shoulder until the
later stages of the disease.
 Associated nontraumatic and traumatic pathologies include
proximal humerus trauma, sickle cell disease, history of
radiation, Gaucher’s disease, dysbaric disorders, alcohol
intake, corticosteroid use, or a history of systemic lupus
erythematosus.
 The presence of avascular necrosis in other joints, especially
of the hip, are common
 Biceps Long Tendon
Tear/Rupture
 Pain in the anterior shoulder in middle-
aged to older males following heavy lifting
or quick onset of an eccentric load.
 A “pop” may be heard with weakness of
supination and elbow flexion noted.
 Observable distal muscle convexity may
be seen due to retraction of the muscle
toward the remaining attachment.
 Bursitis (Subdeltoid/ Subacromial)

 An insidious onset of pain at the anterior

or lateral shoulder.
 Passive movements are painful especially
at the end range of motion into
abduction, internal rotation, and
horizontal adduction.
 Active movements typically present with
pain during flexion and abduction.
Chronic Fatigue Syndrome
 A new onset of unexplained, persistent, or
recurrent physical or mental fatigue that
substantially reduces activity level, post
exertional malaise, and exclusion of other
potentially explanatory medical or
psychiatric conditions; also requires at least
one symptom from two of the following
categories:
 Autonomic manifestations, neuroendocrine
manifestations, and immune manifestations
Complex Regional Pain Syndrome

 A “burning or throbbing pain.”

 Symptoms typically manifest in the distal
extremity including escalated pain pattern,
swelling, autonomic vasomotor
dysfunction, and impaired upper extremity
function.
Acromioclavicular Dislocation
 Acute onset of superior lateral shoulder
pain with sharp reproduction during
attempts of movement.
 Observable deformity at the
acromioclavicular joint and/or clavicle will
assist with grading the severity of injury.
 Mechanisms may include traumatic high-
velocity injury in younger patients or older
patients with low to moderate velocity
injury, such as a fall on an outstretched hand.
Glenohumeral Dislocation
 Patients, typically male and in their 20s,
who may experience mechanical
symptoms along with pain from soft tissue
disruption in overhead activities.
Sternoclavicular Dislocation
 Anterior shoulder pain coupled with the
patient’s preference toward placing his or
her affective upper extremity in a protective
posture to avoid medial clavicle pain.
 The neck may be postured toward the
affected side. Swelling and/or a lump over
the joint region is palpated.
 The patient may have difficulty with lying
supine and on the affected shoulder.
 Atraumatic dislocations typically occur in
young females with generalized joint laxity.
Erb’s Palsy
 Shoulder pain secondary to a known
neurological injury, possibly occurring at
birth, resulting in significant weakness of the
shoulder musculature.
 Adaptive posturing will be present typically
of 30 degrees of abduction, flexion, 60
degrees of humeral internal rotation, and
potential elbow flexion contracture.
 Pain and limited function will be present due
to secondary osteoarthritis.
Fibromyalgia
 Chronic widespread joint and muscle pain
defined as bilateral upper body, lower
body, and spine pain, associated with
tenderness to palpation of 11 of 18
specific muscle-tendon sites.
Bankart Lesion
 Asymptomatic or minimally symptomatic
with overhead motions.
 The patient more typically presents with
symptoms of glenohumeral instability
secondary to repetitive microtrauma or
dislocation.
Clavicle Fracture
 Immediate pain, inability to move shoulder
and possibly the neck with swelling, and
observable deformity.
 Tenting of the skin is commonly seen.
Hills-Sachs Lesion
 Shoulder instability; the lesion itself is
typically asymptomatic.
 Poorly localized shoulder pain, either
anterior or posterior, is present, especially
with late phase cocking or the early
acceleration phases of throwing or
overhead activities.
Proximal Humerus Fracture
 Pain and bony tenderness in the axilla,
crepitus, and significant limitation of range
of motion.
 The mechanism of injury is typically that
of a fall.
 Incidence increases with age, and women
are more affected than men
Scapula fracture
 Posterior shoulder pain in patients who hold
their involved upper extremity in adduction
with severely restricted motion.
 Weak rotator cuff function may be present,
yet tenderness is localized to the scapula.
 Edema and ecchymosis may be absent.
 Pain may be present with inspiration due to
respiratory muscular attachments.
 A flattened shoulder is typical of a displaced
glenoid neck or acromial fracture
Glenoid Labrum Tears
 Poorly localized anterior or posterior
pain in the shoulder that may range from
constant to episodic and sharp.
 It is typically activity-related shoulder pain
that increases with overhead motion
Gout
 Mechanical impingement signs, such as sharp
pain at the anterior shoulder with
movement from 90 to 120 degrees humeral
abduction, limited overhead movement, and
possible associated rotator cuff tendinitis.
 Typical patient presentation: male, 40 to 60
years old, obese, probable excessive alcohol
intake, with history of gout attacks in other
joints.
 Fever is infrequently present.
 Local warmth and edema may be present.
Hereditary Neuralgic Amyotrophy
 Recurrent sudden episodes of pain and
weakness in the shoulder girdle.
 Patients with this condition are typically
ages 20 to 40 years.
 Episodes may be brought on by physical
exertion, viral illness, or extreme stress.
Heterotopic Ossification/Myositis Ossificans

 Pain with limited passive and active range of motion

with a history of trauma and/or immobilization.
 Development at the proximal humerus is not atypical
following shoulder arthroplasty, but there is
significantly less risk than that which is found after
lower extremity total joint surgery.
 Risk factors for development following arthroplasty
may include rotator cuff tears.
 The development of clavicle heterotopic ossification
after acromioplasty or resection is associated with
patients with a history of chronic pulmonary disease.
 Surgical management is dependent on level of
functional limitation.
 Internal Impingement
(Posterior Glenoid Impingement)
 Posterior shoulder pain and less commonly joint line pain
associated with repetitive positioning of the shoulder into an
abducted and externally rotated position.
 Patients are typically athletes under the age of 40; though
there are case reports of internal impingement in the
nonathletic population.
 Progression of symptoms may be acute onset (more
common with non-throwers) or insidious (more common
with throwers).
 Jobe classified three stages for presentation: Stage I, reports
of stiffness with pain occurring specifically during the late
cocking and early acceleration phases; stage II, progression to
significant posterior joint-line pain with activity; and stage III,
failure to improve with conservative means.
Subacromial Impingement
 Characterized in the earliest stages as sharp
episodic pain at the anterolateral acromion
with radiating pain to the mid lateral
humerus.
 In the later stages, the pain is “toothache
like” and the limitations in physical activity
are more apparent.
 Affected demographics are variable for age,
severity of functional limitations, and pain
reports.
Acromioclavicular Sprain
 An acute onset of superior lateral shoulder
pain with sharp reproduction during
attempts at movement.
 Observable deformity at the
acromioclavicular joint and/or clavicle will
assist with grading the severity of injury.
 Mechanisms may include traumatic high-
velocity injury in younger patients or older
patients with low to moderate-velocity
injury, such as a fall on an outstretched hand.
Sternoclavicular Sprain
 Acute onset of medial clavicular pain with
possible production of sharp pain with
attempts at ipsilateral shoulder girdle
motion, side-lying on the affected side,
and lying supine.
 The neck may be postured toward the
affected side.
 Swelling and/or a lump over the joint
region may be palpated.
Muscle Strains
 Localized pain that is dependent on the
location of the muscle affected.
 Limited active range of motion will be
present and may be correlated with the
action of the injured muscle.
 Tenderness with palpation and muscular
inhibition upon isometric contraction may
be present
Myofascial Pain Syndrome
 Diffuse, deep aching or soreness in the
axioscapular muscles.
 Also included in the presentation are
palpable tender taut bands in the muscles
and trigger points, paresthesias in the area
of trigger points, and weakness of the
affected axioscapular muscle.
Axillary Nerve Injury
 Shoulder pain with abduction and
external rotation or low endurance with
overhead activities.
 Denervation to the teres minor and the
deltoid and sensation to the lateral
shoulder may or may not be spared
Spinal Accessory Nerve Trauma
 Shoulder pain, scapular winging, depressed
shoulder girdle, and limitations in
shoulder range of motion.
 These characteristics are typical following
traumatic disruption of the spinal
accessory nerve affecting the function of
the trapezius.
Suprascapular Nerve Injury
 Deep, poorly localized shoulder pain with
muscular wasting of the infraspinatus or
supraspinatus.
Neuralgic Amyotrophy
(Parsonage-Turner Syndrome)
 Sudden acute onset of burning and severe
pain at the shoulder and into the upper
arm with unknown etiology.
 This pain resolves and precedes the
weakness in the shoulder and shoulder
girdle due to denervation of the muscles.
Neuropathic Arthropathy
(Charcot-Marie-Tooth Disease)
 Generalized pain, burning, paresthesia, swelling, and functional
limitation of the involved joint.
 The symptoms may progress over several months or years.
 Typical onset of symptoms is a benign or unrelated
mechanism of injury.
 Neuropathic arthropathy is a destructive joint disease with
decreased sensory innervation and proprioception to the
involved joint.
 Pathogenesis remains controversial, involving potential
neurovascular, neurotrophic, or central nervous system
pathology.
 Syringomyelia with or without complication of Arnold-Chiari
malformation is a likely underlying contribution to
neuropathic arthropathy at the shoulder and elbow.
 OSTEOARTHROSIS/OSTEOARTHRITIS
Acromioclavicular Joint

 Localized tenderness, pain, or aching in

the lateral deltoid region with overhead
activities and/or shoulder adduction.
 There may be reports of difficulty lying in
an ipsilateral side-lying position.
 A history of heavy lifting or repetitive
overhead activity may be present.
Osteoarthritis of Glenohumeral Joint

 Insidious onset of shoulder pain and

progressive loss of range of motion, most
commonly in an older individual.
 Marked loss of external rotation typically
is present.
 Disuse atrophy of the rotator cuff may
also be present
Osteoarthritis Sternoclavicular

 Absence of pain to possible localized

tenderness to mild aching pain typically of
insidious onset with female patients age 40
or older.
 Swelling may be present over the joint and
may go unnoticed by the patient.
 Aggravating factors may be ipsilateral
shoulder motion.
 Other joints will not be affected and
radiographic evidence may not match the
clinical picture.
Osteomyelitis
 Pain, as well as limited motion of the
shoulder with or without warmth or
swelling.
 Up to 50% of patients with this health
condition may present with nausea,
anorexia, and night sweats.
Polymyalgia Rheumatica
 Aching and stiffness at the bilateral shoulder
joints with radiating pain distally into the
elbows.
 Patients with this condition are typically over
the age of 50 years with a peak incidence at
age 70 to 80 years.
 Involvement of the pelvis and hips is typical
with similar symptoms of aching/ stiffness
with radiation of pain into the knees.
 Distal pitting edema and asymmetric
peripheral arthritis are less typical
Reiter’s Syndrome
 Acute onset with pain and swelling in an
asymmetric multi-plejoint pattern.
 Prolonged stiffness following inactivity is a
common complaint for any of the
involved joints
Rheumatoid Arthritis
 An insidious onset of transitory pain and
stiffness in the shoulder.
 Long-duration stiffness is especially
prevalent in the morning. Shoulder pain is
rarely the first report of pain in
individuals presenting with this condition.
Dermatomyositis
 Myalgia coupled with a significant decline in
function such as difficulty standing from a chair,
stepping off curbs, and performing overhead
activities of daily living.
 A skin rash most commonly precedes the
muscular manifestations and may be present on
the eyelids, in a V sign or a shawl sign.
 The heliotrope rash is presentin 25% of cases, and
in 30% of cases, lesions appear on the
metacarpophalangeal, proximal, and distal
interphalangeal joints.
 Sensation remains normal and deep tendon
reflexes are rarely affected early in the disease
Polymyositis
 A gradual onset of mild muscle pain in the
shoulder girdle and other proximal
muscles, associated with proximal muscle
weakness that causes difficulty with daily
activities such as walking, ascending and
descending stairs, and rising from chair
Psoriatic Arthritis
 An insidious onset of lumbopelvic and
hip pain associated with psoriasis.
 The severity of arthritis is uncorrelated
with the extent of skin involvement.
 Pitting nail lesions occur in 80% of
individuals with this condition.
Dactylitis, tenosynovitis, and
peripheral arthritis also are common.
Scleroderma
 Myalgia, arthralgia, fatigue, weight loss,
limited mobility, and hardened skin about
the hands, knees, or elbows.
 This condition occurs in individuals
between 25 and 55 years of age, and is
four to five times more likely in women
than men.
 Additional symptoms may include dry
mouth and eyes, as well as Raynaud’s
phenomenon.
Systemic Lupus Erythematosus
 Lower back pain radiating to the hip
and groin and is associated with
fatigue and joint pain/ swelling
affecting the hands, feet, knees, and
shoulders.
Rotator Cuff Tear
 Involve weakness, posterior atrophy over
the involved muscle, and pain at the
lateral brachium with attempts at
movement.
 Night pain, mechanical impingement signs,
and crepitus are common
Septic Arthritis
 A primary report of limited range of motion
at the shoulder because an absence of pain
as the primary complaint is not uncommon.
Local signs of infection will be present.
 A low-grade or transient fever may occur in
anywhere from 40% to 90% of the cases.
 During the acute phase, the patient might
note incapacitating shoulder pain with fever
and chills.
Skeletal Tuberculosis (Pott’s Disease)

 Limited range of motion, pain, and the

presence of a soft tissue abscess.
 Typically there is an absence of
constitutional symptoms.
Biceps Long Tendinitis
 Involve aggravating activities of lifting,
pulling, and reaching with pain and
tenderness to palpation at the anterior
shoulder at the level of the bicipital
groove
Rotator Cuff Tendinitis
 Weakness, atrophy, palpatory tenderness
over the involved tendon, and pain at the
lateral brachium, night pain, painful arc of
movement between 80 and 120 degrees
of upper extremity elevation, and
crepitus.
Rotator Cuff Tendinosis
 Weakness, atrophy, pain at the lateral
brachium, night pain, painful arc of
movement between 80 and 120 degrees
of upper extremity elevation, crepitus, and
less frequently tenderness to palpation of
the involved tendon.
Chondrosarcoma
 Shoulder pain and restricted motion
located in various areas of the proximal
humerus in a middle aged patient.
 A nonpainful mass may be the initial
presenting sign
Enchondroma
 Pain that is unassociated with the lesion
itself, since the lesion is typically
asymptomatic.
 Yet association of pain with this type of
lesion needs to be explored for potential
malignancy.
 Loss of range of motion and night pain
are not consistently present.
Lipoma

 A small, mobile, and palpable mass if

superficial; however, these are typically
intramuscular, smaller than 5 cm, and
asymptomatic
Lung Tumor
 Shoulder pain associated with changes in
function, shortness of breath, and
probable Horner’s sign.
 Metastases, Including From Primary Breast, Kidney,
Lung, Prostate, and Thyroid Disease

 Unremitting pain in individuals with the

risk factors of previous history of cancer,
age 50 years or older, failure to improve
with conservative therapy, and
unexplained weight change of more than
10 pounds in 6 months.
Osteoblastoma
 Pain and limited shoulder range of
motion.
 Night pain is typically present.