Shoulder pain DDx

Shoulder pain – Differential Diagnosis

Common causes

• Rotator cuff injury
• Adhesive capsulitis
• Shoulder joint OA
• AC Joint Problems
• Cervical radiculopathy

Must Not Miss

• Myocardial Infarction /Angina
• Polymyalgia rheumatica
• Rheumatoid arthritis
• Infection
  • Pneumonia
  • Septic arthritis
  • Osteomyelitis
• Malignancy
  • Pancoast tumour
  • Multiple myeloma
  • Metastases

Easily missed

• Referred Gallbladder disease
• Connective tissue diseases

Red flags

• Significant trauma
• Hot/painful/swollen joint with little movement
• Severe pain/progressive symptoms
• Bony tenderness/swelling/deformity
• Nocturnal pain
• Systemic symptoms
  • (fever, night sweats, weight loss)
• History of TB, HIV, Cancer

Investigations to consider

• FBC, CRP/ESR
• U&Es, LFTs, bone profile, Troponin
• Auto-antibody screen, Rheumatoid factor
• ECG
• Shoulder X-ray
• CXR
• USS
• CT/MRI scan
• Bone scan