Shoulder Pain

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Signs and Symptoms

Shoulder pain varies in intensity from mild to severe. Depending on the cause for shoulder pain, additional symptoms may include the following:

• Abnormal sensations (e.g., numbness, tingling, coolness)
• Deformity
• Discoloration (bruising)
• Swelling
• Weakness

In some cases, shoulder pain can be difficult to distinguish from neck pain and can spread to the arm and hand (radiate). This type of pain often is associated with pinched nerves in the neck (called cervical radiculopathy), but it also can come and go in some types of shoulder injuries (e.g., instability, dislocation/subluxation).

Diagnosis

To diagnose shoulder pain, the physician takes a medical history and performs a physical examination. In some cases, diagnostic tests also are performed. The medical history includes information about the onset of shoulder pain and the patient's personal (e.g., past injuries, medical conditions) and family history, especially regarding conditions that can be inherited (e.g., arthritis). During the physical exam, the physician locates the exact area of the pain and determines if there is any shoulder instability or limited range of motion.

Diagnostic tests that may be performed include x-rays and other imaging tests (e.g., ultrasound, magnetic resonance imaging [MRI] scan). Standard x-rays can be used to diagnose fractures, bone abnormalities, arthritis, and shoulder separations.

In some cases, a contrast solution that shows up on x-ray is injected into the shoulder joint before the x-rays or MRI scan are taken. This test, which is called an arthrogram, can be used to detect some structural problems in the soft tissues (e.g., tendons, muscles), such as tears.

Ultrasound and MRI scan often are used to help diagnose shoulder problems. These tests are especially helpful for evaluating injuries to the ligaments, muscles, and tendons in the shoulders (e.g., partial or complete tears in the rotator cuff). Ultrasound uses high-frequency sound waves and a computer to create images of structures within the body and magnetic resonance imaging uses electromagnetic energy to create multi-dimensional, highly-detailed images. These tests can provide valuable, accurate information about structures in the shoulders.

Other tests that may be performed include blood tests (e.g., complete blood count [CBC], erythrocyte sedimentation rate [ESR or sed rate]) and joint aspiration (i.e., removal of synovial joint fluid from the shoulder; used to diagnose some forms of arthritis).

Shoulder Pain, Signs and Symptoms, Diagnosis reprinted with permission from painchannel.com
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