Pain in the shoulder area

Shoulder problems including pain, are one of the more common reasons for physician visits for musculoskeletal symptoms. The shoulder joint is the joint with the largest range of motion in the body, and the cause of shoulder pain is not just limited to the shoulder joint but can also be caused by lesions in the surrounding area. However, it is an unstable joint because of the range of motion allowed. This instability increases the likelihood of joint injury, often leading to a degenerative process in which tissues break down and no longer function well.   

Common causes of shoulder pain are rotator cuff pathology, adhesive capsulitis (frozen shoulder), calcific tendinitis (a self-limiting condition due to deposition of calcium hydroxyapatite within tendons), degenerative joint disease, dislocation, fracture, acute trauma, and tumors. Other regions within the body (such as gallbladder, liver, heart disease or disease of the cervical spine of the neck) also may generate pain that the brain may interpret as arising from the shoulder.

Shoulder pain is most prevalent in middle age (45–64 years, from 21–55%), which may be attributed to the normal aging process of shoulder structures including the rotator cuff. This would most likely be due to degeneration, acute injury or pathology. Shoulder pain is also common in the younger age group (adolescents aged 12–18 years, from 12–57%) and can be attributed to a postural relationship associated with increased periods of sitting, advancement of technology with greater usage.

In summary, the prevalence of shoulder pain is influenced by a number of factors: it tends to increase with age, has a strong gender relationship and is more common in women, and is particularly prevalent in psychologically stressed populations, especially women and adolescents.

Following are some of the ways doctors diagnose shoulder problems:

Medical history and physical

• Medical history (the patient tells the doctor about an injury or other condition that might be causing the pain).
• Physical examination of the shoulder to feel for injury and discover the limits of movement, location of pain, and extent of joint instability. However, a systematic review of relevant research found that the accuracy of the physical examination is low.

Diagnostic tests 

Tests to confirm the diagnosis of certain conditions. Some of these tests include:

• X ray (a form of electromagnetic radiation)
• Arthrogram: Diagnostic record that can be seen on an x ray after injection of a contrast fluid into the shoulder joint to outline structures such as the rotator cuff. In disease or injury, this contrast fluid may either leak into an area where it does not belong, indicating a tear or opening, or be blocked from entering an area where there normally is an opening.
• MRI (magnetic resonance imaging): A non-invasive procedure in which a machine produces a series of cross-sectional images of the shoulder.
• Other diagnostic tests, such as injection of an anesthetic into and around the shoulder joint.
  

Pain in the shoulder area may be associated with several diseases include:

Ectopic pregnancy

An ectopic pregnancy is a complication of pregnancy in which the embryo implants outside the uterine cavity. Shoulder pain may be present due to the presence of blood in the abdomen, which can irritate the nerve that travels up to shoulder.

Kehr's sign is the occurrence of acute pain in the tip of the shoulder due to the presence of blood or other irritants in the peritoneal cavity when a person is lying down and the legs are elevated. Kehr's sign in the left shoulder is considered a classic symptom of a ruptured spleen. May result from ruptured ectopic pregnancy.