● Deep venous thrombosis (DVT) of the upper extremity - Compared to a DVT in a lower extremity, DVTs in an upper extremity are less common. The use of a peripherally inserted central catheter (PICC line) or central venous catheter (CVC) is often associated with their onset. Other risk factors include age greater than 40 years, immobilization of the upper extremity, and a history of thromboembolic events (Heil et al., 2017). Upper extremity DVTs affect the subclavian vein or axillary vein. Less commonly involved are the internal jugular and brachial veins. The brachial, ulnar, and radial veins may also be involved (Heil et al., 2017). Symptoms are comparable to those of a lower extremity DVT and include pitting edema or swelling, numbness, or heaviness in the extremity; itching, burning, or coldness of the extremity; redness or warmth; dilated veins; limited range of motion; and low-grade fever. Localized neck or shoulder pain may indicate subclavian or axillary vein thrombosis (Heil et al., 2017). Self-Assessment Quiz Question #1 Heart-related issues can cause shoulder pain because they are both innervated by ________ spinal segments.
● Bacterial endocarditis - The most common musculoskeletal symptom associated with bacterial endocarditis is joint pain, and the shoulder is the joint most often affected. In declining incidence, other joints that are also often affected include the knee, hip, wrist, ankle, metatarsophalangeal and metacarpophalangeal, and acromioclavicular joints. Usually, one or two joints are painful, but some patients have pain in several joints. Joint pain is accompanied by warmth, tenderness, and redness. Limited shoulder active and passive range of motion is expected (Dbeis et al., 2021). One way to distinguish this condition from rheumatoid arthritis (RA) or polymyalgia rheumatica is that morning stiffness is not as prevalent with endocarditis as it is with RA or polymyalgia rheumatica. Patients may not report more limitations in activities of daily living (ADLs) or occupational performance activities in the morning compared to ADL in the afternoon or evening. ● Pericarditis - Inflammation of the pericardium is typically idiopathic, except in developing countries, where it is often caused by tuberculosis (Ismail, 2020). Pericarditis can cause a buildup of fluid in the pericardial sac. This buildup prevents the heart from fully expanding, resulting in chest pain. This pain is comparable to a myocardial infarction (MI) in that it is substernal, is associated with a cough, and may radiate to the shoulder. A pattern of relieving and aggravating symptoms can be used to differentiate the two. Leaning over when seated relieves pericarditis pain, while MI pain is unaffected by position. Pericardial pain often increases with deep breathing, swallowing, or belching, while MI pain does not. Screening for renal causes of shoulder pain The upper urinary tract is in the posterior upper abdominal cavity in the retroperitoneal space. The upper urinary tract can cause ipsilateral shoulder pain when it touches the diaphragm. Shoulder pain of renal cause is typically Screening for gastrointestinal causes of shoulder pain Gastrointestinal (GI) problems can cause ipsilateral shoulder pain if they irritate the diaphragm. According to Ott et al. (2022), the most common GI causes of shoulder pain that are seen in therapy clinics include perforated gastric or duodenal ulcer, gallbladder disease, and duodenal ulcer. Associated symptoms are expected and may include nausea, vomiting, anorexia, melena, and early satiety. Screening for liver and biliary causes of shoulder pain The hepatic and biliary organs (liver, gallbladder, and common bile duct) can cause right shoulder pain. This pain is usually in conjunction with midback and scapular pain. Sympathetic fibers from the biliary system are connected through the celiac and splanchnic plexuses to the hepatic fibers in the region of the dorsal spine. Although the innervation is bilateral, most of the biliary fibers reach the Screening for infectious causes of shoulder pain The most common infectious causes of shoulder pain are infectious (septic) arthritis, osteomyelitis, and infectious mononucleosis. The primary risk factor for these conditions is immunosuppression for any reason. Septic arthritis of the acromioclavicular joint can cause insidious onset of shoulder pain, while septic arthritis of the sternoclavicular joint can cause chest pain. Joint tenderness is typical in these scenarios. A history of intravenous drug use, diabetes mellitus, trauma, or infection are all risk factors for these conditions.
a. C3–C4. b. C4–C5. c. C5–C6. d. C7–T1.
accompanied by other renal symptoms, including generalized abdominal pain, nausea, vomiting, and impaired intestinal motility.
History of previous ulcers should be explored, including an association with non-steroidal anti-inflammatory drugs (NSAID) use. GI bleeding should be suspected when shoulder pain is worse two to four hours after taking an NSAID. The effects of eating on shoulder pain should also be assessed. If shoulder pain is worse between 30 minutes to two hours after eating, this may suggest GI involvement (Heick & Lazaro, 2022). cord through the right splanchnic nerves, producing right shoulder pain. In such cases, shoulder motion would not be compromised, nor would tenderness with palpation be present (Heick & Lazaro, 2022). Patients will report consistent pain that is not exacerbated by ADL or exercise. Activities such as dressing, brushing hair, or overhead reaching would not be limited or cause increased pain. A wound, abscess, or systemic infection can spread to the shoulder and cause osteomyelitis. In adults, symptom onset is typically gradual. In children, it is more sudden. A notable symptom of osteomyelitis is marked tenderness over the site of the infection. Systemic symptoms, such as fever, are also often present and help the examiner recognize that an infection is present.
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