Perhaps no chief complaint is as common as pain in the shoulder and none with a broader list of possible causes. Many of these causes overlap or play a role in the pathology of other processes. In addition, there is often more than one source of pain in the overhead athlete, making the approach not nearly as clear as one would like.2 We begin with pain, describe the differential, and endeavor to describe how to narrow down the list to a few diagnoses to test on physical examination. A list of common causes for pain as chief complaint follows:
• Impingement: classic outlet impingement, internal impingement, subcoracoid impingement
• Rotator cuff: tendinosis, partial-thickness tearing, full-thickness tearing
• Instability: anterior, posterior, MDI
• AC joint pathology
• Biceps and labral pathology
• Chondral defects
• Neurologic: cervical spine nerve root compression, brachial neuritis, thoracic outlet syndrome, suprascapular nerve entrapment
Such a list can be quite daunting unless the examiner stays organized. With a few early questions, the differential can be established and narrowed down. One question to begin with is, simply, "Where is the pain?" Although a seemingly basic question, it is often difficult to get the patient to be specific. We often ask patients to point with one finger to the area. Most patients will respond in any of the ways described in Table 16-1.
Was this article helpful?
Everything you wanted to know about. How To Cure Tennis Elbow. Are you an athlete who suffers from tennis elbow? Contrary to popular opinion, most people who suffer from tennis elbow do not even play tennis. They get this condition, which is a torn tendon in the elbow, from the strain of using the same motions with the arm, repeatedly. If you have tennis elbow, you understand how the pain can disrupt your day.