Definition

The shoulder is a complex joint where overload, injury and disease in joints, muscles, tendons and mucous sacs can cause pain and reduced function. Shoulder pain occurs in up to 50% of the population, and is one of the most common causes of contact with a doctor and other parts of the health care system. The most common causes of shoulder pain are congestion and injury, but rheumatic diseases can also be present. The treatment depends on the cause.

Symptoms

Shoulder pain can be acute or chronic, localizing to the front, side and back. The pain may be constant or just by movement. Night sweats and fever can occur with joint infection.

Examinations

Medical history may include prior injury, congestion, or infection. Other diseases may be related, such as other joint disease, infection or cancer.

Clinical examinations are covered by the observation of possible swelling, pain-signs of movement. Examiner rotates the shoulder outward and inward with the elbow bent. Similarly, outward mobility (abduction) is examined. One can also press against tendons frontally, on the side and behind the shoulder.

Blood tests may include CRP, SR, white blood cells (leukocytes), uric acid, anti-CCP.

Imaging can be done with ultrasound, CT or MRI. With regular X-rays, calcifications, fractures and major arthritis can be detected.

Other: If infection or gout is suspected, puncture and synovial fluid examination may be appropriate.

Causes of shoulder pain

• Acromioclavicular-joint pain (not always clear cause)
• Arthritis (inflammed joints)
  • 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
• Gallstones Colic pain can radiate into the shoulder
• Heart disease with radiation to the shoulder Angina pectoris
• Myocardial infarction
• Impingement syndrome in rotator cuff
• Calcium tendititis (calcification)
• Crystal arthritis (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 (damage to bone tissue)
  • 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) (neuritis)
  • 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 (muscle arthritis)
  • 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 (Muscle inflammation)
  • Muscular weakness in the shoulders
  • The weakness of the thigh muscles is most common
• Reactive arthritis and Reiter's disease (inflammed joints)
  • Occur few weeks after infection of the urinary tract or intestine.
  • Ankles and knees are most commonly attacked

• Injuries to shoulder
  • 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 (tendon injury)
  • Tendinitis
  • Shoulder luxation/ Subluxation

• Thoracic outlet syndrome (pinching of blood and nerves)

Treatment

Treatment of shoulder pain may include observation, medication, injections, physiotherapy or surgery depending entirely on the cause of the disease.

Literature

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

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