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Compressive, invasive referred pain to the shoulder
Clinical Orthopaedics and Related Research
|March 1, 1983
Summary
Shoulder pain can stem from various local or systemic issues, including thoracic outlet syndrome, cervical spine problems, or lung conditions. Diagnosis involves physical exams, imaging, and nerve tests, with surgery as a last resort.
Area of Science:
- Orthopedics
- Neurology
- Pulmonology
Background:
- Shoulder pain is a common complaint with diverse etiologies.
- It can arise from local musculoskeletal issues or referred pain from systemic conditions.
Purpose of the Study:
- To outline the diagnostic approaches for shoulder pain.
- To differentiate between local and referred causes of shoulder pain.
Main Methods:
- Clinical history and physical examination are crucial for diagnosing thoracic outlet syndrome.
- Diagnostic maneuvers and imaging (cervical spine roentgenograms) aid in identifying nerve-related pain.
- Nerve conduction tests help evaluate peripheral nerve involvement.
- Phrenic nerve pathways are considered for pain referred from thoracic or abdominal sources.
Main Results:
- Thoracic outlet syndrome diagnosis relies on history, physical exam, and specific maneuvers.
- Cervical spine issues and peripheral nerve problems can be identified via roentgenograms and nerve conduction tests.
- Referred shoulder pain can originate from lung neoplasms, parenchymal disease, or pleural/subdiaphragmatic infections via the phrenic nerve.
Conclusions:
- A comprehensive diagnostic strategy is essential for shoulder pain.
- Identifying the source of pain, whether local or referred, guides appropriate treatment.
- Persistent shoulder pain without clear musculoskeletal abnormalities warrants investigation into non-musculoskeletal causes.