The painful shoulder: Part II. Acute and chronic disorders

Fractures of the humerus, scapula and clavicle usually result from a direct blow or a fall onto an outstretched hand. Most can be treated by immobiliz ation. Dislocation of the humerus, strain or sprain of the acromioclavicula r and sternoclavicular joints, and rotator cuff injury often can be managed conservatively. Recurrence is a problem with humerus dislocation, and surg ical management may be indicated if conservative treatment fails. Rotator c uff tears are often hard to diagnose because of muscle atrophy that impairs the patient's ability to perform diagnostic maneuvers, Chronic shoulder pr oblems usually fall into one of several categories, which include impingeme nt syndrome, frozen shoulder and biceps tendonitis. Other causes of chronic shoulder pain are labral injury, osteoarthritis of the glenohumeral or acr omioclavicular joint and, rarely, osteolysis of the distal clavicle.