The painful shoulder

Shoulder pain is usually caused by a small number of relatively common conditions. Clinical history and examination are essential in the diagnosis of shoulder pain, after which investigations often assist in confirming the diagnosis.One of the commonest causes of shoulder pain is rotator cuff disease, which can be due to impingement syndrome (where the acromion impinges on the supraspinatus tendon) or by tears to the rotator cuff muscles. Both conditions can be managed with physiotherapy, but surgery (subacromial decompression, arthroscopic cuff repair) may be indicated. Frozen shoulder is a chronic condition often affecting middle-aged women. It can follow a period of immobility or minor trauma and is usually managed with physiotherapy. Calcific tendonitis is caused by calcium deposition in the supraspinatus tendon and causes severe pain; calcium deposits on plain radiographs are diagnostic. Symptoms gradually settle over time in most cases, but surgical intervention may be indicated. Degenerative disease (e.g. osteoarthritis, rheumatoid arthritis) can also cause shoulder pain and shoulder arthroplasty may be indicated. Shoulder dislocations can lead to an unstable shoulder joint that is prone to recurrent dislocation. Surgery may be required to stabilize the shoulder and repair damage to the labrum or humeral head.Other, less common, causes of shoulder pain (e.g. infection, neuralgic amyotrophy, tumour) are also briefly considered in this review.