- Shoulder pain commonly affects patients of all ages.
- Causes include acute trauma, overuse during sports, infection, and activities of everyday living.
- Age plays an important role in determining the etiology of shoulder pain.
- Onset and characteristics of pain, mechanism of injury, and limitation in activity or sport narrow the differential diagnosis.
- Shoulder pain accounts for 16% of all musculoskeletal (MSK) complaints.
- The lifetime prevalence of shoulder pain is ~70%.
- Predominant etiology varies with age:
- <30 years old: shoulder instability, overuse injuries
- 30 to 60 years old: rotator cuff (RTC) disorder, impingement syndrome, partial tears
- >60 years old: full-thickness tear, glenohumeral OA
The incidence of shoulder pain is 7 to 25 cases per 1,000 patients, with a peak incidence in the 4th to 6th decades of life.
Etiology and Pathophysiology
Pathology varies with cause:
- Trauma—fracture, dislocation, ligament/tendon tear, acromioclavicular (AC) separation
- Overuse—RTC pathology, biceps tenosynovitis, bursitis, muscle strain, apophyseal injuries, labral injuries
- RTC disorders most commonly result from repetitive overhead activity, leading to RTC impingement with a three-stage progression:
- Stage I: tendinopathy
- Stage II: partial RTC tear
- Stage III: full-thickness RTC tear
- Subacromial bursitis can occur with RTC disorders but is rarely an isolated diagnosis.
- Age related: In pediatric athletes, instability and physeal injuries are more common. With increasing age, the incidence of AC and glenohumeral joint OA, adhesive capsulitis, and RTC tear rises.
- Rheumatologic: rheumatoid arthritis, polymyalgia rheumatica, fibromyalgia
- Infectious: septic arthritis
- Referred pain: neck, gallbladder, diaphragm
- Repetitive overhead activity
- Overhead and upper extremity weight-bearing sports (baseball, softball, swimming, tennis, volleyball)
- Weight lifting: AC joint disorders
- Rapid increases in training frequency or load (often associated with improper technique)
- Muscle weakness or imbalance
- Trauma or fall onto the shoulder
- Diabetes, thyroid disorders and other autoimmune diseases, female gender, and ages 40 to 60 years are the risk factors for adhesive capsulitis.
- Maintain strength and range of motion (ROM).
- Avoid repetitive overhead activities such as pitch counts in younger baseball athletes.
- Proper technique (pitching, weight lifting)
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