II. Causes: Acute Musculoskeletal or Glenohumeral Causes of Shoulder Pain

  1. Fracture
    1. Clavicle Fracture
    2. Scapula Fracture
    3. Humeral Fracture
  2. Glenohumeral Conditions
    1. Septic Arthritis of the Shoulder must be considered in all cases of acute Shoulder Pain
    2. Superior Labrum Anterior to Posterior Tear (SLAP Lesion, Labral Tear)
  3. Non-Glenohumeral Conditions
    1. Diffuse Shoulder strain
    2. Acromioclavicular joint separation
    3. Tear of long head of biceps

III. Causes: Chronic Musculoskeletal Causes of Shoulder Pain

IV. Causes: Neuropathic Shoulder Pain

  1. Shoulder-Band Syndrome
  2. Herpes Zoster (Shingles)
  3. Brachial Neuritis
  4. Carpal Tunnel
    1. Commonly causes Shoulder Pain (in addition to wrist)
  5. Cervical Disc Syndrome

V. Causes: Abdominal Source of Referred Shoulder Pain

  1. Referred pain from phrenic nerve (diaphragm) radiation sites
    1. Cutaneous fourth cervical Nerve (top of Shoulder)
    2. Innervates top of Shoulder
    3. Supraspinous fossa
    4. Over acromion or clavicle
  2. Etiologies
    1. Abdominal Trauma
      1. Ruptured Spleen
      2. Liver, Pancreas or Kidney injury
    2. Gastric Ulcer or Duodenal Ulcer perforation
    3. Subphrenic abscess
    4. Diaphragmatic Pleurisy
    5. Acute Pancreatitis
    6. Gallstones
    7. Appendicitis with peritonitis
    8. Liver Abscess
    9. Fitz-Hugh-Curtis Syndrome (Perihepatic inflammation)

VI. Causes: Thoracic Source of Referred Shoulder Pain

  1. Cardiac (e.g. Pericarditis, Myocardial Infarction)
    1. Left arm, or Shoulder
    2. Neck, lower jaw, and interscapular
  2. Pulmonary (Carcinoma, Pneumonia, or abscess)
    1. Pancoast (Apical Tumor of superior sulcus lung)
  3. Hiatal Hernia
  4. Other mediastinal, aorta, esophageal causes

VII. Causes: Malignant Sources of Referred Shoulder Pain

  1. Thyroid Cancer
  2. Breast Cancer
  3. Lung Cancer
  4. Renal Cancer
  5. Hodgkin's Lymphoma
  6. Prostate Cancer
  7. Bone Metastases (Multiple Myeloma most common)
    1. Shoulder metastases (less common)
    2. Ribs, spine, and Pelvis (more common)
    3. XRay and bone scans have high False Negative Rate
  8. Paget's Disease
    1. Periosteal bone formation
      1. Results in cranial or spinal impingement
    2. Usually minimal or no symptoms
    3. Increased pain
      1. Think Sarcomatous degeneration

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Ontology: Shoulder Pain (C0037011)

Definition (MSH) Unilateral or bilateral pain of the shoulder. It is often caused by physical activities such as work or sports participation, but may also be pathologic in origin.
Concepts Sign or Symptom (T184)
MSH D020069
ICD10 M25.519 , M25.51
SnomedCT 45326000, 203124006, 203132003
Dutch schouderpijn, pijn; schouder, schouder; pijn, Pijn, schouder-, Schouderpijn
German Schulterschmerz, Schulterschmerzen
Italian Dolore alla spalla, Dolore di spalla
Portuguese Dor no ombro, Dor de Ombro
Spanish Dolor de hombro, dolor en el hombro (hallazgo), dolor de hombro, dolor de hombro (hallazgo), dolor en el hombro, Dolor de Hombro
Swedish Skuldersmärta
Finnish Hartiakipu
Russian BOLI PLECHEVYE, PLECHEVYE BOLI, БОЛИ ПЛЕЧЕВЫЕ, ПЛЕЧЕВЫЕ БОЛИ
English Pain, Shoulder, Pains, Shoulder, Shoulder Pains, Shoulder Pain, Pain in unspecified shoulder, Pain in shoulder, Shoulder Pain [Disease/Finding], shoulder pain, Pain;musculoskeletal;shoulder, Pain;shoulder, shoulder pains, pain in shoulder, Shoulder region pain, Shoulder pain (disorder), Shoulder pain, Shoulder pain (finding), pain; shoulder, shoulder; pain, musculoskeletal shoulder pain
Japanese カタツウ, 肩痛, ケンツウ
Czech Bolest ramene, rameno - bolest, bolest ramene
Polish Ból barku, Zespół bolesnego barku
Hungarian Vállfájdalom
Norwegian Skuldersmerter
Croatian Bol u ramenu
French Douleur scapulaire, Scapulalgie, Douleur de l'épaule