[Shoulder pain: assessment, diagnosis and treatment of common problems]

Shoulder pain is a common complaint seen at the primary physician's clinic, and it is the third most common musculoskeletal complaint after back and neck pain. Shoulder pain can have a wide range of etiologies: trauma caused from a sprain or a simple muscle strain to a large tear of one of the shoulder stabilizer muscles. Some shoulder pathologies can cause chronic pain and limitation in shoulder range of motion such as impingement syndrome, adhesive capsulitis, calcified tendonitis, cervical radiculopathy, glenohumeral osteoarthritis, and biceps tendonitis. The physician who attempts to diagnose the cause for his patient's shoulder pain faces a great challenge due to the large number of etiologies that can lead to such a complaint. The physician has a large number of tools at his disposal starting from a thorough history emphasizing the time and character of the shoulder pain, range of motion and the ability to do everyday activities, to a wide range of imaging modalities such as X-ray, ultrasound and magnetic resonance imaging. Most of the causes of shoulder pain are adequately treated non-surgically with treatments such as physiotherapy, antiinflammatory medication and local corticosteroid injections. However, some situations necessitate surgical intervention in order to correct and restore the patient's prior level of shoulder function. The physician's ability to correctly diagnose and recommend appropriate lines of treatment, taking into consideration the patient's problem, age, medical condition and prior level of function is the secret to successful treatment, recovery of the patient's shoulder function and most important, patient satisfaction.