Yudu - sportEX dynamics - 1999-2010

SHOULDER PAIN DIFFERENTIAL DIAGNOSIS

UPPER TRAPEZIUS

LOWER AND MIDDLE TRAPEZIUS

RHOMBOID MAJOR

Figure 2b: Muscles involved in the upper crossed syndrome (posterior aspect)

imbalance CAN BE COMPLICATED pain

abnormal movement

dysfunction

Figure 3: The cycle of muscle dysfunction and pain

imbalance T2

whereas non-musculoskeletal sources will not. Patients with undiagnosed systemic illness may be referred for treatment of a (apparent) musculoskeletal complaint, or could be refereed for treatment because the systemic illness is behaving like a musculoskeletal problem.

CONCLUSION Differential diagnosis of shoulder pain can be complicated because any pain which affects the shoulder can cause it to act as though the pain was indeed originating from that site (1). As therapists we need to be aware that if patients are not responding appropriately to our treatment, we need to review our differential diagnosis.

Figure 4: Optimal position of scapular

neural mechanosensitvity is suspected, specific examination which is beyond the scope of this article, is required.

TAKE HOME MESSAGE The therapist needs to recognise musculoskeletal and non- musculoskeletal causes of pain. In general, musculoskeletal sources of pain will be influenced by movement,

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DIFFERENTIAL DIAGNOSIS OF SHOULDER PAIN

References 1. Mennell J. Joint Pain 1965. Out of print.

2. Walsh RM, Sadowski GE. Systemic disease mimicking musculoskeletal dysfunction: A case report involving referred shoulder pain. Journal of Orthopaedic and Sports Physical Therapy 2001;31(12):696-701

3. Hadler NM. Clinical Concepts in Regional Musculoskeletal Illness 1987

4. Melzack R and Wall PD. The Challenge of Pain. ISBN 0140256709

5. Wolfe F, Simons DG, Fricton J et al. The fibromyalgia and myofascial pain syndromes: a preliminary study of tender points and trigger points in persons with fibromyalgia, myofascial pain syndrome and no disease. Journal of Rheumatology 1992;19:944-951

6. Chaitow L, Liebenson C. Muscle Energy Techniques. ISBN 0443101140. Buy on Amazon

online

7. Janda, V. 1988. Muscles and Cervicogenic Pain Syndromes In Physical Therapy of the Cervical and Thoracic Spine. ISBN 0443065640 Buy on Amazon

8. Zohn DA. Musculoskeletal Pain Diagnosis and Physical Treatment. Out of print.

THE AUTHOR

Ian Horsley is currently technical lead physiotherapist for the North and regional lead physiotherapist for the North West region at the English Institute of Sport. He graduated as a physiotherapist from Manchester in 1989, completed his MSc in sports physiotherapy in 2002, and is currently completing his PhD research on shoulder injuries within professional rugby. Ian has previously worked with England Rugby, and the Yorkshire Lawn Tennis Association, and is currently clinical director at Back In Action Rehabilitation in Wakefield.