| Shoulder pain is a very common complaint responsible | | | | clinical judgment are invaluable in guiding the |
| for millions of doctor visits each year. Shoulder pain | | | | confirmatory diagnostic tests I order. In other words, |
| can result from literally hundreds of causes and | | | | successful treatment starts with first establishing the |
| affects every age group. | | | | correct diagnosis. |
| Because it is common to have some pain with certain | | | | Once a working diagnosis is formulated, the |
| activities and sports like pitching, swimming, etc. it can | | | | appropriate confirmatory diagnostic tests are ordered. |
| be difficult to tell the difference between benign | | | | Many patients request an MRI for pain-one of the |
| shoulder pain and shoulder pain that is trying to send | | | | problems with just ordering an MRI of the shoulder for |
| you a message that something is really wrong. This | | | | all shoulder pain is that the diagnostic accuracy of an |
| can be difficult at all levels including professional | | | | MRI is highly variable depending on the diagnosis. |
| athletes- highlighted with the recent episode involving | | | | Especially for tears deep in the shoulder an MRI |
| professional pitcher Stephen Strasburg. For overhead | | | | arthrogram is more accurate. Because no diagnostic |
| sports like baseball, the margin of error can be very | | | | test is perfect, it is not unusual to have a patient come |
| small and a benign appearing pain can quickly become | | | | in with a diagnostic test with a report positive for some |
| a career ending injury. | | | | sort of tear, but upon performing the history and |
| Nerves are ultimately responsible for signaling pain and | | | | examination the patient has a completely different |
| the shoulder is surrounded by a rich network of | | | | cause for the pain and the diagnostic test results are |
| nerves- many are on their way to other sites in the | | | | an incidental asymptomatic finding. The opposite |
| body- sometimes pain or injury in one area of the | | | | scenario is also common-the history and examination |
| body is actually felt in another area. This is sometimes | | | | are strongly positive for pathology in a particular region, |
| called referred pain. Some common sources of | | | | but the diagnostic report is normal. I always review |
| referred shoulder pain include but are not limited to pain | | | | diagnostic images and tests personally because having |
| or disease in the gallbladder, liver, lung, diaphragm, heart, | | | | the benefit of clinical correlation often indicates |
| and neck (cervical spine). Some diseases-like diabetes- | | | | pathology on the diagnostic test that would not have |
| that cause neuropathy or alter the body's ability to feel | | | | been picked up otherwise. Rotator cuff tears, for |
| pain can also increase the risk for shoulder problems. | | | | example, are a common cause of shoulder pain, but |
| Injury, overuse, arthritis, and genetics along with routine | | | | the MRI appearance and diagnostic accuracy for |
| wear and tear can also play an important role in | | | | rotator cuff tears can vary for multiple reasons. |
| shoulder pain. One of the most common nerves often | | | | Pain changes our ability to remain objective and it is |
| overlooked as a source of shoulder pain and disability | | | | common for patients to proceed with treatments in an |
| is the suprascapular nerve. | | | | effort to resolve the pain without first having a clearly |
| With this type of pain, it is important to first determine | | | | established diagnosis. As frustrating as shoulder pain |
| what is responsible for your shoulder pain before | | | | can be, we recommend taking the time to establish the |
| jumping ahead with potentially unnecessary, expensive, | | | | correct diagnosis first in order to avoid a failed |
| and sometimes dangerous treatment. For me, this | | | | shoulder surgery. |
| always starts with a thorough history and examination, | | | | In summary, if your shoulder pain has persisted despite |
| which I find to be the most important diagnostic tools | | | | rest and simple common treatments, we highly |
| even though with all the advancements in modern | | | | recommend you discuss the matter with your |
| medicine, it has become more common to rely on | | | | physician to start the process of getting you a firm |
| diagnostic tests. Even though no one examination | | | | diagnosis and ultimately a solution for your shoulder |
| technique by itself is wholly reliable, I find the | | | | pain. |
| combination of multiple techniques combined with | | | | |