Persistent shoulder pain: possible visceral or systemic sources

Abstract

Background: Several case studies and expert commentaries have been published relating to visceral and systemic sources of persistent shoulder pain; yet, as the evidence presented here suggests, more published work is needed. No systematic reviews have been published to date, likely because this problem is not conducive to randomized control trial investigations.

Objectives: This narrative presents a review of the literature of various serious medical conditions that may present as persistent shoulder pain. As physical therapists (PTs) are managing patients with multiple complicated health issues, the PT must be proficient in performing a thorough history and review of systems in order to refer the patient if indicated.

Major Findings: In addition to being proficient in examining the shoulder for neuromusculoskeletal (NMS) conditions, it is important that PTs are competent in the screening procedures that may alert the PT of the need for prompt medical referral. Signs and symptoms that present as an NMS shoulder problem can have visceral origins in the thoracic and abdominal cavities and/or systemic manifestations related to the presence of cancers, diabetes, autoimmune diseases, or infectious diseases. Key points to remember when screening for medical conditions are summarized and outlined.

Conclusions: The cases presented demonstrate why it is important that PTs are responsible for screening for medical pathology. Physical therapists may be the first medical team members to examine patients due to their role as primary health care providers.

Keywords:

• Medical
• Pain
• Physical therapy
• Referral
• Shoulder