How is it Diagnosed?
Shoulder pain is a common complaint with diverse etiologies including musculoskeletal,
neurological, and systemic causes. Diagnosis begins with a detailed history and focused
physical examination to differentiate among causes like rotator cuff injury, adhesive
capsulitis, impingement syndrome, osteoarthritis, and referred pain from the neck or
thorax.
History should address onset (acute vs. chronic), nature of pain (sharp, dull, radiating),
aggravating/relieving factors, associated trauma, and functional limitations.
Occupational and sports history also guide diagnosis.
On physical examination, inspection may reveal deformity, swelling, or atrophy.
Palpation helps localize tenderness. Range of motion testing (both active and passive) is
crucial. Specific orthopedic tests (e.g., Neer’s, Hawkins-Kennedy, Drop Arm test,
Speed’s test) help identify impingement or tendon involvement.
Initial imaging includes X-ray to assess bony structures and rule out fractures,
dislocations, or arthritis. MRI or ultrasonography is used for soft tissue evaluation,
particularly rotator cuff tears, bursitis, or labral pathology.
Electrodiagnostic studies (EMG and nerve conduction velocity) may be used if cervical
radiculopathy or brachial plexus involvement is suspected. Blood tests like ESR and CRP
may assist if inflammatory or infectious causes are suspected.
Referred pain from cardiac or abdominal sources (e.g., myocardial infarction, gallbladder
disease) must also be ruled out when pain is atypical. Accurate diagnosis is essential for
effective management, ranging from conservative care to surgical intervention.