Shoulder Pain Radiation

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					                                    SHOULDER PAIN MAPPING FOR COMMON SHOULDER DISORDERS
                                                                                        Aroonkumar Chouhan a, Zafar Naqui b, Lennard Funk b, c
aFaculty   of Medicine, Stopford Building, The University of Manchester, Oxford Road, Manchester. M13 9PT bDepartment of Orthopaedic Surgery, Hope Hospital, Stott Lane, Salford. M6 8HD, cUndergraduate Medical Education, Hope Hospital, Stott Lane, Salford. M6 8HD

Introduction                                                                               Results                                                                                    Patients with ACJ pathology documented stabbing
                                                                                                                                                                                      pain centred over the anterior and dorsal shoulder,
Shoulder pain is a frequent presenting complaint to                                        Patients with impingement syndrome recorded                                                with no radiation down the arm. Dull aching pain
physicians. Pathology in the shoulder can manifest                                         predominantly sharp pain around the front of the                                           was also recorded predominantly around the dorsal
as pain radiating from the shoulder as well as in the                                      shoulder region and down the back of the entire arm,                                       aspect in these patients.
shoulder itself.                                                                           with dull aching pain radiating to the hand. Burning
                                                                                           pain was also recorded anteriorly.                                                         Patients with glenohumeral arthritis recorded
Pain mapping for specific disorders has been                                                                                                                                          sharp shooting, burning and dull aching pain
                                                                                           Patients with a rotator cuff tear demonstrated a very
described for back pain and hip pain, but not for                                                                                                                                     affecting the entire arm, from shoulder to hand.
                                                                                           similar pattern to impingement patients, except the
shoulder pain.
                                                                                           sharp pain this time radiated to the hand anteriorly
                                                                                           rather than posteriorly, where it was more confined to                                     Numbness and parasthesia was only seen in two
                                                                                           the shoulder region.                                                                       patients with impingement and glenohumeral
                                                                                                                                                                                      Pain radiating below the elbow was more common
Our aim was to ascertain specific patterns of pain                                                                                                                                    in glenohumeral arthritis and impingement
                                                                                                                             ++                                                 +
character and radiation in patients with impingement,                                                                                                                      + ++++
                                                                                                                       + ++ + +
                                                                                                                    +++ ++++                                  + +
                                                                                                                                                                    + + ++ ++++++     syndrome. Burning pain was more common in
                                                                                                                      + + + ++                         + +                   + +++
ACJ pathology, Rotator Cuff Tear and Glenohumeral                                           ++
                                                                                               + ++                                        +
                                                                                                                                                        + +                           glenohumeral arthritis.
                                                                                             ++++ ++                                       + ++
arthritis..                                                                                     + +
                                                                                                   + + + +
                                                                                                                 + +                     +   +
                                                                                                                                                   +    +
                                                                                                ++         +

Methods                                                                                                                                                                              Conclusions
                                                                                            Fig. 1 Impimgement Syndrome                      Fig. 2 Rotator Cuff Tear

We questioned 45 patients attending a shoulder                                                                                                                                       This study confirms that there are specific, common
clinic at Hope Hospital, Salford.                                                                                                                                                    patterns of pain distribution and nature specific to
                                                                                                                                                                                     the common shoulder disorders. It also defines the
The study group comprised of 23 women and 22                                                                                 ++                                                +
                                                                                                                          + + +
                                                                                                                           + ++
                                                                                                                                                                           +         benefit of pain maps as a useful diagnostic tool for
men, with a mean age of 59 years (range 16 to 101                                                                            ++                         +
                                                                                                                                                           +   +
                                                                                                                                                                            + +
                                                                                                                                                  + +
                                                                                                                                                   + +
                                                                                                                                                         + +
years).                                                                                      +++ +
                                                                                             +++ + +                                      + + +
                                                                                                                                           + ++ + +
                                                                                                     +                                           + + +
                                                                                             +                                            + ++ ++++       + +++
                                                                                              +                                                     + +++ + +
All patients completed an upper limb pain map, to                                                                                                         +
                                                                                                                                                          + ++

illustrate the type, severity and radiation of pain. This
was then correlated with the final diagnosis, with the
diagnostic clinician blinded to the pain map.                                                Fig. 3 Acromioclavicular Joint                    Fig. 4 Glenohumeral
                                                                                                       Pathology                                   Osteoarthritis
Any patient with neck symptoms, neck pathology,
                                                                                         + ++
previous shoulder problems or multiple shoulder                                          ++     Stabbing and/or Sharp and/or Shooting Pain
pathologies were excluded from the study.                                                       Burning Pain
                                                                                                Dull and/or Aching Pain
                                                                                                Numbness and/or Pins and Needles

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