Intrinsic shoulder disease
Rotator cuff tendinitis (“impingement”); rotator cuff tendinopathy
Rotator cuff tear
Subacromial bursitis or inflammatory synovitis
Biceps tendinitis
Osteoarthritis: acromioclavicular joint arthritis; Glenohumeral joint arthritis (rare)
Adhesive capsulitis (Frozen shoulder)
Acromioclavicular (AC) separation
Labral tear
Rheumatoid arthritis
Septic arthritis
Calcific tendinitis
Avascular necrosis humeral head
Shoulder dislocation; Shoulder fracture
Metastatic or primary tumor
Neck disease
Osteoarthritis, herniated disk, tumor
Brachial plexus neuropathy; Brachial plexitis/neuritis
Cervical radiculopathy (from arthritis, disk, tumor)
Herpes zoster
Systemic disease
Polymyalgia rheumatica
Fibromyalgia
Referred from chest or abdomen
Myocardial ischemia, infarction
Pericarditis
Pneumonia
Pulmonary embolus
Lung tumor, Pancoast tumor
Thoracic outlet syndrome
Diaphragm
Biliary disease
Intra-abdominal bleeding (ectopic, ruptured ovarian cyst)
Ruptured abdominal viscus
Ruptured spleen
Abdominal malignancy
Psychiatric and other
Psychiatric d/o
Thinking through the differential diagnosis
-Always examine the joint above and below. In this case, the neck and the elbow should be examined and considered in the differential as origins for shoulder pain.
-The differential of shoulder pain can be categorized into intrinsic shoulder disease, pain from the neck or elbow, pain referred from the chest or abdomen, psychiatric issues, and systemic disease like PMR.
–Shoulder pain by age and anatomic location.
Further Reading
Am Fam Physician. 2000 Jun 1;61(11):3291-3300. https://www.aafp.org/afp/2000/0601/p3291.html
https://www.aafp.org/afp/2016/0715/p119.html
Am Fam Physician. 2011 Feb 15;83(4):417-422. Adhesive Capsulitis: A Review. https://www.aafp.org/afp/2011/0215/p417.html