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Shoulder Pain Associated with the Rotator Cuff

The typical patient (male or female) with shoulder pain is between the ages of 30 and 50. Common complaints are neck pain that radiates down one arm, limited range of motion, and/or pain when moving the shoulder or arm. Sometimes pain is not readily associated with the shoulder. Pain may be worse at night and makes sleep difficult. Often, an over-the-counter non-steroidal anti-inflammatory drug does not help reduce or eliminate pain. Certainly, this is a challenging patient.

Differential Diagnosis
A diagnostic starting point is to evaluate the distribution of the patient’s symptoms. This involves evaluating the shoulder and scapula to determine the sequence of pain. It is suggested to examine the neck as well to exclude its involvement.

Stressing the rotator cuff may show whether or not there is weakness and may help to differentiate a tear from tendonopathy. Other considerations include:

  • X-ray evidence of osteoarthritis of the acromioclavicular joint and a history of shoulder pain, difficulty sleeping, and resistance to range of motion.
  • Focus on the cervical and scapular areas, especially the posterior scapular musculature. With the patient standing, observe for loss of symmetry when the arms are positioned along the sides, outward, and forward.
  • The scapula may be the “weak link” between the thoracic and scapular areas.
  • Palpate for trigger points (eg, myofascial assessment).
  • Shoulder pain associated with the rotator: differentiate between impingement, full thickness tear(s), and tendon problem(s).

An injection is often the first-line of treatment for the patient presenting with severe pain. The injection appropriate may be modified if MRI and/or lateral ultrasound results are available.

First published on: November 6, 2013