Shoulder and Arm Pain
Shoulder pain may arise locally, quite commonly including fractures, various forms of arthritis, and sprains of any of the supporting ligaments. On the other hand, identical pain may arise remote from the site of pain, in the cervical or upper thoracic spine. Fractures should be easy to identify. The pain of acute arthritis is usually constant, with exacerbation on attempted movement. Rheumatoid arthritis is usually easy to identify, as is degenerative arthrosis, and both are likely to involve more than one joint, although perhaps not at the onset of symptoms. Polymyalgia rheumatica may cause some diagnostic difficulty, as, contrary to some teaching, the erythrocyte sedimentation rate (ESR) is not invariably raised. Ligamentous sprains are suggested from the history and confirmed by adequate examination. In this case exacerbation of pain is commonly found on certain movements only, on stretching joint capsules and their supporting ligaments. One of the commonest conditions in this region is anterior capsulitis. Frozen shoulder is a term I prefer not to use, except to imply the chronicity of shoulder pain related to unsuccessful or inappropriate treatment.
KeywordsCarpal Tunnel Syndrome Carpal Tunnel Shoulder Pain Thoracic Spine Steroid Injection
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