![]() If older than 40 years: rotator cuff tearsĪdhesive capsulitis, glenohumeral osteoarthritis If younger than 40 years: shoulder dislocation/subluxation If older than 40 years: rotator cuff tears, adhesive capsulitis, glenohumeral osteoarthritis If younger than 40 years: instability, rotator cuff tendinopathy It can be divided into six diagnostic categories: (1) rotator cuff disorders, including tendinosis, full or partial thickness tears, or calcific tendinitis (2) adhesive capsulitis (3) glenohumeral osteoarthritis (4) glenohumeral instability (5) acromioclavicular joint pathology and (6) other chronic pain, including less common shoulder problems and non-shoulder problems. 3, 4 Shoulder pain is defined as chronic when it has been present for longer than six months, regardless of whether the patient has previously sought treatment. Part II, which appears in this issue of AFP, discusses the treatments of chronic shoulder pain that are consistent with recent evidence-based guidelines. 2 Part I of this two-part article will provide the primary care physician with a simple, effective approach to the diagnosis of chronic shoulder disorders such as rotator cuff pathology, adhesive capsulitis, acromioclavicular osteoarthritis, glenohumeral osteoarthritis, and instability. Shoulder pain is responsible for approximately 16 percent of all musculoskeletal complaints, 1 with a yearly incidence of 15 new episodes per 1,000 patients seen in the primary care setting. For shoulder instability, magnetic resonance imaging arthrogram is preferred over magnetic resonance imaging. Magnetic resonance imaging and ultrasonography are preferred for rotator cuff disorders. Plain radiographs may help diagnose massive rotator cuff tears, shoulder instability, and shoulder arthritis. Imaging studies, indicated when diagnosis remains unclear or management would be altered, include plain radiographs, magnetic resonance imaging, ultrasonography, and computed tomography scans. Positive apprehension and relocation are consistent with the diagnosis. In patients younger than 40 years, glenohumeral instability generally presents with a history of dislocation or subluxation events. In patients who are older than 50 years, glenohumeral osteoarthritis usually presents as gradual pain and loss of motion. Acromioclavicular osteoarthritis presents with superior shoulder pain, acromioclavicular joint tenderness, and a painful cross-body adduction test. Clinical presentation includes diffuse shoulder pain with restricted passive range of motion on examination. Adhesive capsulitis can be associated with diabetes and thyroid disorders. A clinical decision rule that is helpful in the diagnosis of rotator cuff tears includes pain with overhead activity, weakness on empty can and external rotation tests, and a positive impingement sign. ![]() Rotator cuff disorders include tendinopathy, partial tears, and complete tears. ![]() Common conditions that can result in chronic shoulder pain include rotator cuff disorders, adhesive capsulitis, shoulder instability, and shoulder arthritis. Shoulder pain is defined as chronic when it has been present for longer than six months. ![]()
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