Shoulder pain diagnosis

Diagnosing shoulder pain is focused on the range of movement with some diagnostic scans being used too.

How is shoulder pain diagnosed?

Most cases of shoulder pain can be diagnosed by a shoulder specialist or physiotherapist taking a detailed history of the problem and confirming the suspected problems with physical examination tests.

The two most useful clinical testing procedures take advantage of the large range of motion of the shoulder as well as the ability to isolate particular groups of muscles and tendons.

Firstly, clinicians will want to establish what is referred to as a capsular pattern of stiffness to the joint. This test involves keeping the elbow at ninety degrees while rotating the hand away from the side to externally rotate the shoulder. If there is significant pain or stiffness then it is likely that there is a problem with the shoulder joint (glenohumeral joint) such as a frozen shoulder or osteoarthritis.

Secondly, tests to isolate the rotator cuff tendons are performed by asking the patient to resist certain movements. These tests place load on particular muscles and tendons. This can determine if there is pain arising from these tissues and also whether there may be a significant rotator cuff tear as in these cases the tendons are unable to transfer the tensile force across the joint.

Which scans and test may help?

Three main forms of imaging used in musculoskeletal and orthopaedic medicine are X-rays, MRI scans and ultrasound scans. Each of these different scans have their own purpose in diagnosing shoulder pain.

X-rays are the primary diagnostic tool in cases of suspected shoulder fractures but are also of use in determining the extent of age related osteoarthritis to the joints of the shoulder complex. Osteoarthritis of the AC joint as well as the glenohumeral joint may be evaluated well with X-rays. Furthermore, when there are symptoms of subacromial impingement an X-ray can help in determining to what degree osteoarthritis and bony spurs from the AC joint may be contributing to the problem.

Ultrasound scans are an excellent way of assessing any possible inflammation, calcium deposits and any tears to the tendons of the rotator cuff. An ultrasound scan also has the advantage that it can assess the shoulder as it moves. This can be very useful in determining whether there are any signs of mechanical subacromial impingement during elevation of the shoulder.

MRI scans provide a very detailed view of the bone, cartilage and soft tissue of the shoulder. Some orthopaedic surgeons may request an MRI scan prior to undertaking any surgery for subacromial or rotator cuff related shoulder pain. MRI scans are also very useful in picking up areas of inflammation that X-rays and ultrasound scans cannot detect as well as tears to the labrum of the shoulder. When specifically looking for labral tears your specialist may request a contrast dye injection to the shoulder be performed prior to the MRI scan to highlight this structure even more.

In some cases which require complex surgical planning, or for the diagnosis of certain types of shoulder fractures, a CT scan may also be requested as this gives a shoulder surgeon an even more detailed view of the bony anatomy of the shoulder.  

Can shoulder pain be a sign of a serious medical condition?

The vast majority of shoulder pain is due to an underlying injury or degenerative changes to the joint and surrounding muscles and tendons. Very occasionally there may be an underlying medical problem causing the shoulder pain. This is an extremely rare occurrence and an examination by a doctor or physiotherapist can establish normal, mechanical shoulder pain over any more serious pathology.

Immune system problems known as autoimmune diseases may also give rise to joint inflammation. Often these inflammatory responses are felt throughout the body but the shoulder joint/s may be affected by conditions such as psoriatic arthritis and rheumatoid arthritis.

A process known as osteonecrosis may affect the shoulder joint which leads to loss of bone mass due to a lack of blood supply. This condition normally affects individuals who have suffered a trauma or who have risk factors such as metabolic problems or who have been on courses of steroid medication in the past/present.

Often when there are serious underlying medical problems there may be other associated symptoms such as night sweats, weight loss and a feeling of lethargy and malaise. Constant pain and significant nocturnal pain can also be a feature of more serious causes of shoulder pain which can be complicated due to these symptoms being very prevalent in the early stages of a frozen shoulder as well. As such, it is recommended that when suffering with any of these symptoms an individual should book a clinical examination by a qualified clinician who will be able to differentiate between any serious pathology and mechanical shoulder pain after a clinical examination and possibly imaging.

Shoulder conditions

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