• Shoulder pain in the posterior boarder is often from cervical spine (Neck Pain) • Shoulder joint pain is often felt in the upper arm

Approach for DDx

1. Rule out Inflammation arthritis, infection, fracture → Refer to Arthritis

2. Rule out malignancy → Constitutional symptom , XR, MRI

   • BONE Metastasis
   • Sarcoma

3. Rule out referred or radiating pain

   • Joint above (cervical spine) and joint below (elbow)
     • Cervical spine is the MOST common site, almost always posterior
       • Neck Pain
       • Cervical Radiculopathy
   • Non-articular causes:
     • Right shoulder:
       • Lung
       • Gallbladder
     • Left shoulder:
       • Lung
       • Heart - CAD
       • Diaphragm
       • Spleen
   • Compensatory changes due to referred pain

   

4. DDx of MSK Pain based on Anatomy

   1. Posterior
      • Referred: Cervical Radiculopathy
      • Muscle: Myofascial Pain Syndrome
   2. Anterior
      • Tendon: Rotator Cuff Tendonitis & Bursitis (Antero-lateral)
      • Articular: OA - Osteoarthritis → GH OA (Anterior)
      • Cartilage: Labrum Tear

Investigation

Physical Exam

• Shoulder Exam
• Injection Test

Imaging

• MRI if suspect:

  • Cervical Radiculopathy if need surgery
  • Rotator Cuff Tendonitis & Bursitis
  • Labrum Tear (with contrast)

• Joint XR OA Finding if suspect:

  • GH OA