lOMoARcPSD|5734770
lOMoARcPSD|5734770
SHOULDER PAIN DIFFERENTIAL DIAGNOSIS
Condition Symptoms Signs Investigations Management
Impingement • Pain, weakness and • Painful arc 60-120 • USS shoulder Conservative
syndrome – restricted movement abduction • X-ray (AP, axillary, • Patient education and reassurance, reduce/avoid overhead activities
supraspinatus • Hx of heavy lifting, • Muscle wasting transscapular) – • Shoulder exercise - Physiotherapy with goal of optimising function
tendon impinged repetitive movement – • Restriction of active dislocation/arthritis • Ice pack to shoulder 20min several times/day – wrap in towel
between acromion especially above shoulder movement, full passive /calcific deposits Medical
and humeral head level but painful • C-spine X-ray if • Painkillers – paracetamol, NSAIDs
referred neck pain • Steroids injections – intraarticular
suspected Surgical
• MRI – instability • Subacromial decompression – arthroscopy under GA
ROTTATOR CUFF DISORDERS
Rotator cuff tear • Young people – trauma • Severely restricted • Bloods – FBC, Conservative
• Atraumatic in elderly – abduction – ESR/CRP – if red • Patient education, reduce/avoid overhead activities
caused by bony spurs or supraspinatus flags present • Physiotherapy, exercise, ice pack
intrinsic degeneration • If arm is passively Medical
• Often asymptomatic but abducted beyond Red flags: • Painkillers – paracetamol, NSAIDs
may cause pain radiate 90degree, able to abduct • Hx of malignancy • Steroids injections – intraarticular
along the arm further with deltoid • Weight loss Surgical
• Deformity • Rotator cuff tendon repair – arthroscopy under GA
• Mass/swelling
Calcific tendonitis • Pain, restricted movement • Pain on abduction • Ascites/abdo pain Conservative
from deposits of • Overlying skin • Patient education, reduce precipitating factors
hydroxyapatite in tendon • Physiotherapy, ice pack, exercise
erythema – tumour
• Worse with elevating arm or infection Medical
• More common in women • Fever – • Painkillers – paracetamol, NSAIDs, steroids injection
malignancy/ • Aspiration/lavage
Infection Surgical
• Change in shoulder • Open/arthroscopic shoulder surgery – excise deposit
Adhesive capsulitis • Females, 40-65y • Generalised shoulder contour – Conservative
(Frozen shoulder) • Pain and stiffness espy on pain – restricted passive dislocation • Patient education (info leaflet), encourage early activity
external rotation – putting and active • Hx of • Physiotherapy – joint mobilisation + stretching exercises
on jacket • Most severe with trauma/convulsion Medical
GLENOHUMERAL DISORDERS
• More common in people external rotation – dislocation • Painkillers – paracetamol, NSAIDs, TENS
with diabetes/prolonged • Sensory/motor • Intraarticular steroids injection
immobilisation deficit – Surgical
neurological lesion • Rarely done – manipulation under anaesthesia/arthroscopic arthrolysis
Osteoarthritis • Most common >60y • Crepitus upon movement Conservative
• May affect other joints • Restricted ROM • Education, advice and access to information
• Painful, tender, stiff • Effusions • Lifestyle changes – weight loss, local muscle strengthening exercise, ice pack
• Worse throughout the day • Physio and OT input – promote function, reduce adverse effects on ADL
and after exercise Medical
• Painkillers – PCM, NSAIDs (PPI cover), COX-2i, opioids, intraarticular steroids
Surgical
• Joint replacement
lOMoARcPSD|5734770
SHOULDER PAIN DIFFERENTIAL DIAGNOSIS
Condition Symptoms Signs Investigations Management
Impingement • Pain, weakness and • Painful arc 60-120 • USS shoulder Conservative
syndrome – restricted movement abduction • X-ray (AP, axillary, • Patient education and reassurance, reduce/avoid overhead activities
supraspinatus • Hx of heavy lifting, • Muscle wasting transscapular) – • Shoulder exercise - Physiotherapy with goal of optimising function
tendon impinged repetitive movement – • Restriction of active dislocation/arthritis • Ice pack to shoulder 20min several times/day – wrap in towel
between acromion especially above shoulder movement, full passive /calcific deposits Medical
and humeral head level but painful • C-spine X-ray if • Painkillers – paracetamol, NSAIDs
referred neck pain • Steroids injections – intraarticular
suspected Surgical
• MRI – instability • Subacromial decompression – arthroscopy under GA
ROTTATOR CUFF DISORDERS
Rotator cuff tear • Young people – trauma • Severely restricted • Bloods – FBC, Conservative
• Atraumatic in elderly – abduction – ESR/CRP – if red • Patient education, reduce/avoid overhead activities
caused by bony spurs or supraspinatus flags present • Physiotherapy, exercise, ice pack
intrinsic degeneration • If arm is passively Medical
• Often asymptomatic but abducted beyond Red flags: • Painkillers – paracetamol, NSAIDs
may cause pain radiate 90degree, able to abduct • Hx of malignancy • Steroids injections – intraarticular
along the arm further with deltoid • Weight loss Surgical
• Deformity • Rotator cuff tendon repair – arthroscopy under GA
• Mass/swelling
Calcific tendonitis • Pain, restricted movement • Pain on abduction • Ascites/abdo pain Conservative
from deposits of • Overlying skin • Patient education, reduce precipitating factors
hydroxyapatite in tendon • Physiotherapy, ice pack, exercise
erythema – tumour
• Worse with elevating arm or infection Medical
• More common in women • Fever – • Painkillers – paracetamol, NSAIDs, steroids injection
malignancy/ • Aspiration/lavage
Infection Surgical
• Change in shoulder • Open/arthroscopic shoulder surgery – excise deposit
Adhesive capsulitis • Females, 40-65y • Generalised shoulder contour – Conservative
(Frozen shoulder) • Pain and stiffness espy on pain – restricted passive dislocation • Patient education (info leaflet), encourage early activity
external rotation – putting and active • Hx of • Physiotherapy – joint mobilisation + stretching exercises
on jacket • Most severe with trauma/convulsion Medical
GLENOHUMERAL DISORDERS
• More common in people external rotation – dislocation • Painkillers – paracetamol, NSAIDs, TENS
with diabetes/prolonged • Sensory/motor • Intraarticular steroids injection
immobilisation deficit – Surgical
neurological lesion • Rarely done – manipulation under anaesthesia/arthroscopic arthrolysis
Osteoarthritis • Most common >60y • Crepitus upon movement Conservative
• May affect other joints • Restricted ROM • Education, advice and access to information
• Painful, tender, stiff • Effusions • Lifestyle changes – weight loss, local muscle strengthening exercise, ice pack
• Worse throughout the day • Physio and OT input – promote function, reduce adverse effects on ADL
and after exercise Medical
• Painkillers – PCM, NSAIDs (PPI cover), COX-2i, opioids, intraarticular steroids
Surgical
• Joint replacement
