Chronic Shoulder Pain: Part I. Evaluation and Diagnosis

摘要

Pain with an active range of motion between 60 and 100 degrees of abduction is known as the "painful arc" and is associated with rotator cuff disease.20 There are numerous provocative tests for the shoulder. although knowledge of all the tests can be helpful to diagnose pathology, the primary care physician should be familiar with a standard set of tests that should be performed on every shoulder. the Hawkins' test is used to determine impingement (Figures 1a and 1b). tests for rotator cuff pathology are the drop-arm rotator cuff test (Figures 2a and 2b); the empty-can supraspinatus test (Figure 3); the lift-off subscapularis test (Figure 4); and the external rotation test (Figure 5). the cross-body adduction test (Figure 6) is used to determine symptomatic acromioclavicular joint osteoarthritis, and the apprehension and relocation tests (Figure 7) are used to determine shoulder instability. Positive radiographs can be helpful to diagnose calcific tendinitis, acromial spur, humeral head cysts, or superior migration of the humeral head, but are typically normal.3,4,14 OTHER CONDITIONS Numerous other problems that can affect the shoulder are somewhat less common, such as biceps and labral pathology (e.g., SLAlaP tear-superior labrum anterior to posterior tear-an avulsion injury to the root of the long head of the biceps tendon) and multidirectional instability. other conditions are extremely uncommon, such as a suprascapular nerve injury, Parsonage turner syndrome (brachial plexus neuritis), and a neuropathic shoulder from syringomyelia. the shoulder can also be the area of perceived pain for many non-shoulder problems, including fibromyalgia, cervical radiculopathy, and thoracic outlet syndrome. fibromyalgia is notable for classic areas of tender points.