Studies have shown that two out of every three Americans will experience shoulder pain at some point in life. Common causes of pain in the shoulder include bursitis, a rotator cuff tear, degenerative arthritis or tendinitis of the biceps.
If a person is having shoulder pain, is it possible that it could be coming from somewhere
else? The answer is definitely yes, and here is an overview.
A neck problem such as arthritis may only cause pain in the neck, but it can also cause pain that shifts through the trapezius and shoulder blade and into the shoulder itself. This needs to be kept in mind during the work up of shoulder pain, especially in middle-aged and older individuals.
A cervical nerve root that is pinched and inflamed such as C-4, C-5 or maybe even C3 can refer pain into the shoulder and mimic as shoulder pathology. When a nerve root is pinched in the neck and gets inflamed, the resulting pain is called radiculopathy. Not all pinched nerve symptoms come out of a textbook, so the shoulder can easily be affected.
One way to delineate between the two (shoulder pain from the neck or shoulder) is to perform a simple diagnostic injection of numbing medicine into the shoulder. This is often placed into what is called the subacromial space but it can also be placed into the shoulder joint itself.
If the pain is completely relieved, then the shoulder itself could be deemed to be the source of the problem. This may be rotator cuff bursitis, tendonitis or a painful cuff tear. If significant pain remains, these external sources should be look at further.
Carpal tunnel syndrome has also been known to refer pain backwards into the shoulder from time to time. While it’s not a frequent occurrence, the exam should look at this possibility.
The most concerning reasons a person may have shoulder pain Is from a cardiac event. Angina and a heart attack can refer pain into the jaw as well as into the left shoulder. This may go on for weeks prior to a significant event. So there should be a low threshold for suspecting a cardiac issue, and workup appropriate.
Another cause of shoulder pain that does not involve the shoulder joint itself could be pinching of the suprascapular nerve. The nerve itself goes through what is called the spinoglenoid notch and may be compressed and cause shoulder pain from there. The acromioclavicular joint may lead to shoulder pain as well, and it should be palpated since it is not in the shoulder joint but actually very close to the skin.
The biceps tendon has two origins around the shoulder. One of the origins is actually in the shoulder joint and the second is outside. The person may be having tendinitis from the area outside the shoulder joint, so physical examination can help determine if this is the case.
The bottom line here is that shoulder pain can easily be coming from a source outside the shoulder. Special care during the physical examination, imaging studies and potentially diagnostic injections should be taken to ensure that this is not missed.
Arizona Injury Medical Associates offers premier care for the injured worker, along with those injured in auto accidents.