The Painful Shoulder

PAIN in the shoulder may result from lesions of a gross nature, such as fractures, dislocations, tuberculosis, bone tumours, and infective arthritis, and may also be due to conditions of the cervical spine, the neck, the apex of the lung and pleura, and obstruction of the cervico-axillary outlet. As well as this, pain may be felt in the shoulder from visceral disturbance, notably from heart and gallbladder disease. When these abnormalities are excluded there still remains a welldefined group of conditions of the shoulder in which there is limitation or alteration in the range of movement, pain on attempted movement, sometimes muscular wasting, and usually no radiographic evidence of abnormality. Certain morphological and anatomical considerations must be recalled to appreciate the problems of pathology, symptomatology, and treatment.