[Non-traumatic shoulder pain].
BACKGROUND
Shoulder pain (usually non-traumatic) is the third most common cause of consultations for musculoskeletal pain in primary health care. This article discusses challenges within diagnostics and treatment of non-traumatic shoulder pain.


METHODS
The article is based on literature identified through a non-systematic search in PubMed and the Cochrane library.


RESULTS
One clinical test alone is generally not sufficient to make a pathoanatomical diagnosis. The incidence of degenerative changes in the normal population makes it difficult to interpret diagnostic images. MR is mainly indicated as part of a preoperative assessment and upon a specific indication. For diagnosis of the rotator cuff, ultrasound is as good as MR. Clinical studies do not show clear effects of specific treatment. This may be caused by methodological weaknesses of the trials evaluated and that patient characteristics and placebo effects contribute to the diagnosis. Injection with glucocorticoids seems to be well founded in patients with adhesive capsulate (frozen shoulder). With subacromial pain, supervised physical exercise and surgical treatment have similar effects, but there is not sufficient evidence to recommend particular treatments for rupture.


CONCLUSIONS
Non-traumatic shoulder pain is usually diagnosed adequately from the medical history and a combination of clinical tests; conservative treatment is most often adequate. When diagnostic imaging is required, ultrasound should be the first choice.
Ortopedisk avdeling, Oslo universitetssykehus, Rikshospitalet, 0027 Oslo, Norway. jens.ivar.brox@rikshospitalet.no
Jens Ivar
JI
Brox
Per
P
Sunde
Cecilie Piene
CP
Schrøder
Kaia
K
Engebretsen
Øystein
Ø
Skare
Ole Marius
OM
Ekeberg
Niels Gunnar
NG
Juel
D000700:Analgesics / Q000627:therapeutic use; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008279:Magnetic Resonance Imaging; D026741:Physical Therapy Modalities; D011859:Radiography; D017006:Rotator Cuff / Q000000981:diagnostic imaging / Q000473:pathology; D012422:Rupture, Spontaneous / Q000000981:diagnostic imaging; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000601:surgery; D020069:Shoulder Pain / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D014463:Ultrasonography
D000700:Analgesics; D005938:Glucocorticoids