What is the workup for a patient with shoulder and finger pain, possibly indicating a condition such as cervical radiculopathy or peripheral neuropathy?

From the Guidelines

The workup for a patient with shoulder and finger pain should begin with a thorough history and physical examination to determine the likely cause, followed by plain radiographs of both the shoulder and hands, and potentially an MRI of the shoulder or ultrasound for further evaluation, as recommended by the most recent guidelines 1. The initial assessment should include evaluating the onset, duration, and character of pain, along with aggravating and alleviating factors. For the shoulder, evaluate range of motion, strength, and perform special tests like Hawkins, Neer's, and empty can tests to assess for rotator cuff pathology or impingement. For fingers, examine for swelling, redness, deformity, and assess grip strength and fine motor skills. Basic laboratory tests should include complete blood count, erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor, and anti-CCP antibodies to screen for inflammatory conditions. Some key points to consider in the workup include:

• The use of radiography as a useful initial screening modality for acute shoulder pain of all causes, as stated in 1 and 1
• The potential need for MRI or MR arthrography for assessment of soft-tissue injuries, as mentioned in 1 and 1
• The role of ultrasound in assessing rotator cuff injuries, as noted in 1 and 1
• The importance of considering traumatic causes of shoulder pain, as discussed in 1 The most appropriate initial imaging study is plain radiographs of both the shoulder and hands, as it is a safe, fast, and low-cost modality that can effectively demonstrate many forms of shoulder and hand pathology, as recommended by 1 and 1.

From the Research

Patient History and Physical Examination

• A thorough history and physical examination are essential in diagnosing the cause of shoulder and finger pain 2, 3, 4.
• The history should include the time and character of the pain, range of motion, and the ability to perform everyday activities 4.
• A standard physical examination can prompt the examiner to focus on specific tests to further evaluate the shoulder and limit the differential diagnoses 2.

Diagnostic Pathway

• The diagnostic pathway for shoulder pain includes the patient's history, physical examination, and imaging studies such as X-ray, ultrasound, and magnetic resonance imaging 5, 4.
• Ultrasound is an important tool in the diagnostic and therapeutic pathway, especially when surgery is being considered 5.
• Correlating clinical assessment with imaging signs is crucial in making a diagnosis 5.

Treatment Options

• Treatment for shoulder pain can include rest, nonsteroidal anti-inflammatory drugs, and corticosteroid injections 3, 4.
• Physiotherapy and local corticosteroid injections are also effective in treating most causes of shoulder pain 4.
• In some cases, surgical intervention may be necessary to correct and restore the patient's prior level of shoulder function 4.
• Acetaminophen and ibuprofen are commonly used to manage rotator cuff-related shoulder pain, with ibuprofen showing improvement in pain severity and functional activity 6.

Specific Conditions

• Common causes of shoulder pain include supraspinatus tendinitis, bicipital tendinitis, impingement syndromes, and frozen shoulder 3.
• Subdeltoid subacromial bursitis, glenohumeral joint capsulitis, calcific tendinosis, and acromioclavicular joint osteoarthritis are also important diagnoses to consider 5.
• Long head of biceps tendinosis and rotator cuff tears can also cause shoulder pain and may require specific treatment approaches 5.