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shoulder pain

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Shoulder pain may be:

  • referred
  • intrinsic

The `scratch test' tests the ability of the patient to scratch the opposite scapula in three ways. Ability to do so suggests that the joint and its tendons are not at fault. Once referred pain has been excluded, the common intrinsic causes of shoulder pain may be distinguished by examining the shoulder.

The four most common causes of shoulder pain and disability in primary care are rotator cuff disorders, glenohumeral disorders, acromioclavicular joint disease, and referred neck pain (1).

Blood tests and radiography are indicated only if there are "red flag" indicators such as symptoms and signs of systemic disease (weight loss, generalised joint pains, fever, lymphadenopathy, new respiratory symptoms); history of cancer; or concerning local features such as a mass lesion or bony tenderness or swelling (1)


  1. Mitchell C et al. Shoulder pain: diagnosis and management in primary care. BMJ 2005; 331:1124-8


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