00:00
There are a lot of potential causes
for shoulder pain
that is outside of the
actual shoulder.
00:05
We want to make sure
that you take
a very thorough
history
and there's some clues as
to what might be
a potential extra-glenohumeral cause
of shoulder pain.
00:16
If a patient comes in presenting
with shooting,
complaining of burning,
numbness,
tingling of their
shoulder,
and maybe radiating pain
down their extremity,
you have to think that
there might be
more of a potential
neurologic cause.
00:29
So, you have to do a
more thorough exam
of the cervical spine. You may
perform more special tests
to make sure that it's
not a cervical disc
or a potential compression
of the brachial plexus
as it comes down and
innervates the arm.
00:42
Again, shooting, burning pain,
radiating pain,
think a little bit more of a potential
neurologic cause.
00:49
Patients that come in complaining
of pain of the shoulder
may also have pain
being referred
from the abdominal
region.
00:56
Issues with the gallbladder,
the stomach,
the diaphragm can irritate
the organs
and send a referred pain
to the shoulder.
01:05
This is also true for
cardiac issues.
01:09
Everybody knows that if someone
has a cardiac event,
a lot of times it may
radiate pain
to the left shoulder
and jaw.
01:17
So you always have
to rule out
a potential cardiac
issue
if someone presents
with shoulder pain.
01:23
Infections of the lungs and
the thoracic cage
could potentially also
refer pain
because of irritation
of the pleura.
01:31
Any sort of apical
lung tumor
may also irritate
the viscera
and cause referred pain
to the shoulder.
01:39
Also, you also always have
to rule out
pulmonary embolism as
a potential cause
for shoulder
pains.
01:46
In this chart, we're
differentiating
the different structures that
could potentially
cause pain in the
shoulder.
01:52
There are some structures
within the shoulder
at the glenohumeral joint that
could cause pain.
01:58
Then there's extraglenohumeral
joint structures
that are outside of the
actual joint itself
that could potentially cause
shoulder pain.
02:06
So let's take a look at the
glenohumeral sources.
02:10
Sometimes we could have
some degeneration,
calcifications of the
actual humerus
and the glenoid fossa
which could cause
pain at the
shoulder.
02:17
Any sort of injury,
inflammation,
tear of the rotator
cuff muscles
and these tendons could
cause pain.
02:24
Suprahumeral joint is the space
above the humerus.
02:27
So impingement and
compression
of the structures above the
suprahumeral joint
or any sort of inflammation
could cause pain there.
02:35
The capsule that surrounds the
glenohumeral joint,
those thickened ligaments
that sometimes
be torn or inflamed
or injured.
02:42
These four things
are possible
glenohumeral joint issues that
could cause pain.
02:49
Outside the
joint itself,
so extra glenohumeral
joint issues
are structures that
potentially could get
inflamed and injured
around the joint
that could cause
shoulder pain.
02:59
The bicep tendon
itself runs
on the anterior portion
of the humerus.
03:03
So, you could
sometimes
from overuse or
inflammation
have bicep
tendon pain.
03:08
We talked about
the clavicle
and how if you have irritation
of the clavicle,
if you have any sort of displacement
or injury
to the A-C or S-C joints
in the clavicle,
that could really limit joint motion
and cause pain.
03:20
The scapulothoracic joint
is the motion
of the scapula and
the thoracic.
03:24
Remember, we need
5 degrees of motion
at that scapula for every 15 degrees
of motion
of the shoulder
joint.
03:30
So if that scapula is restricted,
matted down,
or has any sort of
muscle spasm
that prevents the
scapula
from moving on the
thoracic area,
that could cause
shoulder pain.
03:41
Then the subscapularis
bursitis,
this is outside of the actual
glenohumeral joint itself.
03:47
This bursa is underneath
the scapula.
03:49
If it's inflamed
and irritated,
that could
cause pain
every time you try to
move the joint.
03:54
There are some
red flags
that you need to be
aware of
when you're evaluating
your patients.
03:59
We talked about before being
really weary
with patients that
have shoulder pain
that is also
associated with
any sort of chest pain or
shortness of breath
because of potential
heart disease
or issues with
the lung.
04:14
If there's some sort
of unexplained
sensory or motor deficit,
we're thinking that
there might be some sort
of compression
or irritation of nerves,
so cervical disc
or any sort of compression of
the brachial plexus
or the nerves somewhere
along the track.
04:29
If a patient has a history
of trauma
with acute
disabling pain
or any sort of significant
weakness,
you need to make
sure that
neurovascularly,
everything is intact.
04:39
Again, trauma, seizures,
electric shock,
or loss of a normal
contour
are just different signs
and symptoms
that it raises your index
of suspicion
of something else
is going on
that you really need to take
more action quicker.
04:52
Any sort of redness
around the skin,
any unexplained
fever,
any time the patient looks
systemically unstable,
there might be some
sort of infection
going on that's causing
the pains and issues.
05:03
Patients with history
of cancer,
some sort of unexplained
deformity,
mass, or swelling, you need
to make sure
that it's not some sort of
growth going on.
05:12
We could utilize special
orthopedic tests
to help narrow down
our differential.
05:16
These special tests have
been developed
to help identify and elicit
certain responses
to confirm our
suspicion.
05:26
But they do have limited
sensitivity and specificity.
05:29
So you really need to take
it in the context
of the patient presentation,
the examination,
and also apply any
additional imaging
as needed to confirm your
suspected diagnosis.