Elsevier

Mayo Clinic Proceedings

Volume 74, Issue 8, August 1999, Pages 785-794
Mayo Clinic Proceedings

Subspecialty Clinics: Orthopedic Surgery
A Commonsense Approach to Shoulder Problems

https://doi.org/10.4065/74.8.785Get rights and content

Shoulder pain is a common entity in a primary care physician's practice. The unique anatomy of the shoulder allows for almost unrestrained motion in all planes. A thorough history and physical examination are important to ensure efficient patient evaluation. Further assessment may include radiographie and diagnostic laboratory tests. This article presents an organized approach to the anatomy, physiology, and pathology of common shoulder disorders for the primary care physician. The distinction between disorders that are intrinsic or extrinsic to the shoulder joint is discussed. Treatment and the need for appropriate referral are described.

Section snippets

ANATOMY

The shoulder girdle is composed of 3 bones and 4 articular surfaces. The clavicle, scapula, and proximal humerus provide the bony framework. The joints include the sternoclavicular, acromioclavicular, glenohumeral, and scapulothoracic articulation (Figure 1). The clavicle acts to strut the shoulder and allows the limb to swing free of the trunk. The broad flat scapula is the source of origination for the rotator cuff muscles, including the supraspinatus, infraspinatus, teres minor, and

History

A focused history is the root in diagnosing shoulder ailments; details concerning symptom onset, duration, and intensity, as well as aggravating or alleviating factors, should be uncovered. The patient's occupation, avocations, and age may help to define lifestyle and expectations. Handedness of the patient is a valuable detail. Additionally, a history of systemic or articular disease should be sought. Prior evaluation and treatment should be well documented.

Patient age may help the clinician

Intrinsic Conditions

Impingement Syndrome and Rotator Cuff Tear.

Anterior shoulder pain primarily of a mechanical nature and associated with overhead activity is often termed “impingement syndrome.” As implied, this may encompass numerous causes. Ninety percent of atraumatic shoulder pain is related to inflammation of the rotator cuff tendons and subacromial bursa. Three stages have been described to interpret the clinical findings.8 Stage I (edema and hemorrhage) describes an overuse-type injury in the young,

SUMMARY

Shoulder pain is a common complaint seen in the primary care physician's practice. Determining the cause requires a thorough understanding of the anatomy, physiology, and pathology of this complex joint. Classifying pathologic conditions as intrinsic or extrinsic may be helpful. Each condition has unique historical, clinical, and radiographie features. A detailed history and a focused physical examination are the cornerstones to diagnosis and treatment.

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