Mystery of Shouder Joint

Why it is difficult to diagnose shoulder cases ???

Shoulder joint may looks like a simple joint to normal individuals but I don’t think it is as simple as it looks like. Shoulder joint is like a” blue deep water pond” which looks simple and easy from outside but most difficult to stand if once you step inside.

Shoulder joint is a mystery because there are so many conditions in the shoulder joint that shows similar features and posses same symptoms. Because of this reason it is most difficult to conform the diagnosis.

This is not only the reason that makes shoulder joint different. There are so many other reasons that make a therapist or physician to misdiagnose and difficulties in diagnosis.

For example; Any patient complaining of decrease ROM in the shoulder joint and pain in the movement, may have problem in other joints likes SC (sternoclavicular) joint, AC (acromioclavicular) joint or ST (scapulothoracic) joint. Because for complete ROM of shoulder joint other joints (SC, AC and ST) movement should not be restricted. Therefore any pathological conditions related to these joints may decrease ROM of shoulder joint.

And any neurological problems like brachial plexus lesion or injury produce radiating pain to the shoulder joint and UL. And any problem in heart, gall bladder and liver may produce referred pain around shoulder region. So, this may be another reason that create problem while diagnosing shoulder cases.

Another reason for shoulder being difficult to diagnose; it is one of the common joint that is used in our most of ADL. We don’t use other joint like hip and knee while sitting and lying but we use shoulder joint. We use shoulder joint in activities of daily living (ADL) like combing, brushing, eating, etc. which makes it more prone to injury and thus difficult to diagnose. This is the joint that permit all movements in all planes. Like flexion/extension, med/lat rotation, abduction/adduction and circumduction. As it has global movements, it makes difficulties in diagnosing.  

Anatomy of shoulder joint is also another factor that makes it more prone to injury. Very large head of humerus articulate with comparatively small glenoid fossa because of which it is most common joint to dislocate.   

So, because of these reasons shoulder joint is difficult to diagnose as compared to other joints like knee, wrist or elbow joint. Therefore, it is very important to check all conditions and also important to assess peripheral joint while dealing with any shoulder cases.