Shoulder pain can range from simple muscle strain to sophisticated nerve pain or referred pain from heart disease. The common problems are Rotator Cuff syndrome/ Rotator Cuff tear, Frozen Shoulder, Impingement syndrome, Arthritis and Calcification. Shoulder injuries such as fractures or tendon injuries must be concerned in trauma cases.

This is how I approach the patient.

• Starting by general history taking, asking for characteristics of the pain, any related symptoms/ numbness, aggravating/ relieving factors, pain at night, clicking, swelling, occupations of the patient is also important, due to modern/ computer lifestyle, and trauma history.

• I observe patients’ general appearance, posture, body alignment and basic vital signs. Physical examination which related to symptoms of the patient. After localizing the pain by the patient, usually starting by range of motion of the shoulder joint in active and passive, sometimes it may be painful with or without weakness, followed by different specific strengthening tests, depending on the possibility of suspicious problems. I also check the cervical spine, nerves and upper extremities condition, especially those who have pain around Trapezius or shoulder blade area. Different areas of trigger points will be examined. If heart or lung or neurological conditions cannot be ruled out, I usually consult the related specialist to make sure about these serious diseases.
• For investigations such as X-rays, Ultrasound, or MRI scan, depending on the suspicious problem (s) from history taking and physical examination. Usually I start with X-rays and / or Ultrasound which do not take much time and are not so expensive. However, in some cases who are highly suspicious of Rotator cuff tear or joint instability, MRI shoulder will be done directly. Some specific cases may require a nerve test or MRI cervical spine or Lidocaine injection test (Impingement test).

• Treatment ranges from conservative treatment to operative treatment. In general, conservative treatment, such as rest, activity modification, physical therapy or injection with Corticosteroid/ Anti-inflammatory/ Platelet-Rich Plasma (PRP) link ไปหน้า PRP page, is started firstly. Then consider for operative treatment if not improved in the follow-up visit(s). But in some conditions, such as Complete Rotator cuff tear or Displaced fracture, surgery will be indicated in the first place.

There are various types of Shoulder pain that need different investigations. Therefore, you need to consult with an Orthopedist to ensure that you received an accurate and essential necessary medical solution to you as a personalized treatment.