Shoulder Pain. Illustration CDC [Public domain], via Wikimedia Commons

Occurrence and causes

Shoulder pain occurs in up to 50% of the population, and is one of the most common causes of contact with a physician and other parts of the health care system. The most common causes of shoulder pain are congestion and injury, but rheumatic diseases may also be present. Treatment depends on the cause.

• Arthritis
  • Rheumatoid Arthritis (Arthritis)
  • Septic arthritis (infection)
• Osteoarthritis
  • Most often after previous damage
• Biceps tendonitis
  • The front of the shoulder
• Borrelia infection with arthritis after tick bite
  • Most commonly in the knees, but shoulder inflammation occurs
• Bursitis (bursa inflammation)
  • Most often subachromial on the outside (lateral)
• Frozen shoulder (Adhesive capsulitis)
• Fibromyalgia / Myofascial pain syndrome
  • Chronic pain in multiple parts of the body
  • Most often women
• Impingement syndrome in rotator cuff
• Calcium tendititis (calcification)
• Crystal Arthritis
  • Pseudogout: Calcium pyrophosphate crystals, most often elderly people, acute attacs
  • Gout: Rarely in shoulder joint, but occurs. Most commonly in known, severe gout
• Osteomyelitis (Skeletal infection)
• Osteonecrosis / Avascular necrosis
  • Pain in the skeleton
  • After high doses of Prednisolone or other cortisone
  • By Systemic lupus erythematosus (SLE)
• Pancoast tumor
  • Cancer from the upper lung that grows and affects the nerves
  • Shoulder Pain
  • Radiating pain
  • Horner's syndrome (miosis, ptosis, enophthalmus, anxiety)
• Plexus Brachial Neuritis (Parsonage-Turner Syndrome)
  • Acute neck, shoulder and arm pain
  • Reduced feeling and force during the first 4 hours or the first weeks
  • Muscle wasting (atrophy) after 2-6 weeks may occur.
  • Investigated with neurography and EMG (neurologist),
  • MRI neck and shoulder may show slight swelling (edema)
  • The spinal fluid is normal
  • Blood tests normal
  • Spontaneous recovery after a few weeks to months is expected
• Polymyalgia rheumatica
  • Rarely before 65's age
  • New strong pain and stiffness in both shoulders
  • At the same time in the pelvis and both thighs
  • Worst in the morning
  • High CRP and ESR in blood samples
• Polymyositis
  • Muscular weakness in the shoulders
  • The weakness of the thigh muscles is most common
• Reactive arthritis and Reiter's disease
  • Occur few weeks after infection of the urinary tract or intestine.
  • Ankles and knees are most commonly attacked

Shoulder pain can stem from many different tendons, muscles and joints. Illustration: National Institute Of Arthritis And Musculoskeletal And Skin Diseases (NIAMS) [Public Domain], by Wikimedia Commons

Shoulderpain after injury

• Acromolecular-jointed injury
• Armplexus / injury
• Neck injury
• Biceps tendon injury
• Fracture
• Cervical radiculopathy (nerve damage)
• Clavicle fracture (Clavicula fracture)
• Overload / repeated damage
  • Profession
  • Ball games
  • Sports
• Rotator cuff damage
• Tendinitis
• Shoulder luxation/ Subluxation

Other conditions with shoulder pain

• Acromioclavicular-joint pain
• Thoracic outlet syndrome
• Gallstones
  • Colic pain can radiate into the shoulder
• Heart disease with radiation to the shoulder
  • Angina pectoris
  • Myocardial infarction

Literature

• Juel NG, 2019 (suggestions for treatment in the primary health service)
• Engebretsen KB, 2015

• Bindevevssykdommer.no
• Vaskulitt.no