Pain to the shoulder joint is localized to the site of pathology or pain can also be referred from else where.
Pain in and around the shoulder can be referred from same side Diaphragmatic stimulation, or on right side from gallbladder irritation or post-operative pain from cholecystectomy. Right shoulder pain can be referred from the apical Lung (Tumor or SOL) though rare. Left shoulder pain can be referred from Diaphram or as a part of cardiac symptom. Pain around the shoulder especially felt radiating from the neck down to the Scapula or medial scapula border with accompanying numbness usually has its origin in the cervical spine.
Pain or symptoms of the shoulder which are localized to the shoulder can be divided according to the age group of the patient presenting with the symptoms
Age group up to 20 yrs
Most the shoulder conditions in this group are related to Instability, Scapular Problems or Muscular sprain patterns
Age group from 20 to 45
In this age group the general population can be divided into people actively involved in sports activities and those with more sedentary life style. Most of the active individuals involved in recreational sports usually complain of Instability of the shoulder( Shoulder dislocation), other labral pathologies like the SLAP or Posterior labral complains. Second category of patients complain of Biceps and related issues with specific diagnosis of Biceps Tendinitis. AC Joint Pain in the same group is usually seen in patients involved in heavy weight lifting at the gym leading to localized AC joint pain with lot of disability of the shoulder.
Rotator Cuff associated complains in this age group is not common and where ever involved is due to other comorbidities like Diabetes and hypothyroidism.
Age group from 45 to 65
Most of the common shoulder complains are in this age group. Patients with history of Diabetes, hypothyroidism are more associated with tendinous conditions of the Rotator cuff. Tendinosis of the rotator cuff is likely associated with degenerative changes in the rotator cuff. Also due to its precarious blood supply specially in the area of attachment of the footprint of rotator cuff makes it more prone to develop tendinosis.
Shoulder pain and Scapula
Scapula and its biomechanics is a poorly understood concept among the general orthopaedic surgeons. By the time the patients with scapular conditions present to the Shoulder surgeon it is usually many months if not year to make the right diagnosis of the condition. The disability due to the scapular pain and loss of work hour is tremendous in today’s times since this condition is common in working population especially the laptop carrying population. In fact in my experience this is a separate group of patients seen more often in the opd past decade. These patients are over jealously treated as Fibromyalgia a condition which doesn’t exist except in the books.
Scapular Pain and Neck Pain
Scapular pain is usually felt around the medial border of the scapula, as well as at the angle of the scapula. Sometimes the patients complains of neck pain often associated with scapular dyskinesia due to muscle imbalance in the sedentary population. This complain of neck is falsely interpreted to Cervical pain and the patient undergoes many x-rays and even MRI of the neck in search of pathology . This set of patients with neck pain actually are showing signs of trapezius over activity due to imbalance between seperate group of muscles involved in the biomechanics of the scapula. This set of patients might be a group with weak CORE who spend hours sitting on laptops and PCs.
Vitamin D Deficiency and Neck Pain
People with high risk for vitamin D deficiency especially the ones with no significant sunlight exposure especially people working night shifts are prone to develop muscular spasms and pain. The common symptoms among this group is chronic neck pain and upper back pain. Such people don’t respond to NSAIDS and physical therapy unless they are supplemented with Vitamin D after blood level monitoring.
