Shoulder pain

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Shoulder pain may be referred from the cervical spine or be localized to a particular structure within the shoulder girdle. The pain may arise from the acromioclavicular joint, rotator cuff, long head of biceps or the glenohumeral joint. The diagnosis as always relies on careful clinical examination.

Figure 22.34. Cervical spondylosis and C2/C4 subluxation.

Diagnosis varies according to the patient's age. In the younger age group, patients will generally present with symptoms of instability. This may be unidirectional and post-traumatic, or multidirectional and atraumatic. The symptoms are often recurrent in nature. The middle age group usually presents with symptoms of subacromial impingement, rotator cuff degeneration and frozen shoulder. The older age group presents with symptoms consistent with acromioclavicular joint osteoarthritis, subacromial impingement, rotator cuff tears or glenohumeral joint degeneration. This degeneration may be secondary to inflammatory arthritis (rheumatoid arthritis), post-traumatic arthritis, primary osteoarthritis or a massive rotator cuff tear (cuff tear arthropathy, Fig. 22.35).

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