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Shoulder Pain

Shoulder Pain is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • Shoulder pain commonly affects patients of all ages.
  • Causes include acute trauma, overuse during sports, and activities of everyday living
  • Age plays an important role in determining the etiology of shoulder pain.
  • Onset and characteristics of pain, weakness, mechanism of injury, and functional limitation help guide an accurate diagnosis.

Epidemiology

  • Shoulder pain accounts for 16% of all musculoskeletal complaints.
  • The lifetime prevalence of shoulder pain is ~70%.
  • Predominant etiology varies with age:
    • <30 years: shoulder instability
    • 30 to 60 years: rotator cuff (RTC) disorder, impingement tendinopathy, partial tears
    • >60 years: full-thickness tear, glenohumeral OA

Incidence
The incidence of shoulder pain is 7 to 25 cases/1,000 patients, with a peak incidence in the 4th to 6th decades.

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
  • 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
  • Referred pain: neck, gallbladder

Risk Factors

  • 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 age 40 to 60 years are risk factors for adhesive capsulitis.

General Prevention

  • Maintain strength and range of motion (ROM).
  • Avoid repetitive overhead activities (pitch counts).
  • Proper technique (pitching, weight lifting)

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Citation

Stephens, Mark B., et al., editors. "Shoulder Pain." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116925/all/Shoulder_Pain.
Shoulder Pain. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116925/all/Shoulder_Pain. Accessed April 26, 2019.
Shoulder Pain. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116925/all/Shoulder_Pain
Shoulder Pain [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 26]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116925/all/Shoulder_Pain.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Shoulder Pain ID - 116925 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116925/all/Shoulder_Pain PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -