Possible Differential Diagnosis

Because the shoulder is a complex structure, it is important to get any problems checked thoroughly so that the correct treatment can be applied.  Other possible shoulder disorders may present in similar ways to supraspinatus tendinopathy.  These include:

  • Rotator cuff tears – a type of rotator cuff tendinopathy, but may be of tendons other than the supraspinatus ie infraspinatus, teres minor or subscapularis.  Chronic tearing, due to summation of microtears from overuse, is more likely to be diagnosed as suprasinatus tendinopathy than acute tears from trauma or injury.  An ultrasound of the shoulder may be a useful technique to differentiate between tears and other tendinopathies.
  • Impingement of other structures in the shoulder
  • Subacromial bursitis – An inflammation of a fluid filled pouch within the shoulder joint
  • Frozen shoulder or adhesive capsulitis (more frequent occurrence in people aged 45-60 years old).
  • Shoulder arthritis (occurs more in people aged over 60 years old).
  • Acromioclavicular disease – disease occurring between the clavicle, or collar bone, and the acromion of the scapula, or shoulder blade (more common in people aged teens to 50 years old)
  • Dislocation and/or fracture
  • Infection (rare)

  

 Pain may also be referred into the shoulder from other areas such as:

  • Neck (common)
  • Myocardial ischemia or infarction (heart attack) – pain from poor blood supply to the heart
  • Diaphragm
  • Polymyalgia rheumatica
  • Some cancer – lung cancer, metastases

If the pain refers past the elbow, into the forearm, wrist or hand, the source is unlikely to be a shoulder issue (Burbank et al., 2008).  Also pain from the shoulder can be referred into the neck due to spasms in the trapezius muscle.

                                    (Burbank et al., 2008 and Boyle, 1969)

 

Further investigations by your doctor should be performed if you have any of the following symptoms:

 

  • History of cancer, signs and symptoms of cancer, unexplained masses of deformities of the shoulder – possible cancer, fractures or dislocations
  • Red skin, fevers/temperatures, general feeling of illness – possible infection
  • History of trauma, epileptic fit, electric shock – possible dislocation
  • History of trauma, acute disabling pain and significant weakness, positive drop arm test (a type of diagnostic test) – possible acute rotator cuff tear
  • Unexplained significant sensory or motor deficits – possible nerve damage

(Mitchell et al., 2005)