Shoulder pain

• Fever and joint erythema: sepsis (although uncommon) should be considered

• Nocturnal wakening is characteristic in both capsulitis of the shoulder and rotator cuff tears and (unlike back pain) is not a red flag

• Severe pain immediately following trauma suggests dislocation. The rounded contour of the shoulder will disappear in the commonest (anterior) dislocation and the patient will resist abduction and external rotation.

• Reduction in all directions of movement implies a “capsular” cause of the pain – be it arthritic or a capsulitis (urgent referral not required)

• Muscle wasting around the scapula may mean a “brachial neuritis” – a curious condition of unknown aetiology

• Apical Pancoast tumour of the lung can infiltrate the brachial plexus causing referred shoulder pain often with wasting of muscles in the forearm and hand, as well as Horner’s syndrome (pupillary constriction and ptosis)

• Acute calcific tendonitis typically occurs in women in the 20–40 year age group. Calcium crystals are deposited medial to the insertion of the supraspinatus tendon. The acute pain usually subsides in a few days with the disappearance of the crystals

• Anterior dislocations are more common than posterior. A fall onto the hand is typical. The anterior bulge may be difficult to detect in the obese or muscular. Damage to the axillary nerve results in the ‘sergeant stripe’ sensory deficit

• Shoulder pain (NHS Choices), Shoulder pain (CKS), Shoulder pain (Arthritis Research UK)​

Frozen shoulder

• Frozen shoulder (NHS Choices)

Shoulder impingement syndrome

• Shoulder impingement syndrome (NHS Choices)

​Arm / Clavicle Fracture

• Broken arm (NHS Choices) / Broken collarbone (NHS Choices)

Thoracic outlet syndrome / cervical rib

• Thoracic outlet: space between clavicle) and 1st rib - narrow passageway crowded with blood vessels, nerves and muscles

• Cervical ribs: anomaly that arise from the lowest cervical vertebrae but their relationship to TOS is not so constant that the two conditions should be seen as synonymous

• TOS: vascular (arterial/venous) & neurogenic. Sx: wasting, numbness, weakness, thrombosis.. H/o trauma, posture, sports? Ix: c-spine Xray (cervical rib), MRI, doppler/angiograms. Rx: conservative, physio, NSAIDS, ca-channel blockers (if vascular instability), surgery (rib removal, decompression)

• Cervical ribs and thoracic outlet syndrome (Patient.info)

Elbow pain

• Elbow pain (Arthritis Research UK)

Olecranon bursitis

• Olecranon bursitis (CKS)

Lateral (Tennis) / Medial epicondylitis (Golfer's elbow)

• Tennis Elbow and Golfer's Elbow (Patient.info), Tennis elbow (NHS Choices), Tennis elbow (CKS)

Hand pain

• Hand pain (NHS Choices), Pain at the base of the thumb (BMJ, 2015)

Carpal tunnel syndrome

• Carpal tunnel syndrome (NHS Choices), Carpal tunnel syndrome (CKS), Carpal tunnel syndrome (patient.info)

Dupuytren's disease

• Dupuytren's disease (CKS)

Mallet / Trigger finger

• Mallet finger (NHS Choices), Trigger finger (NHS Choices)

Raynauld's phenomenon

• Bloods, topical nitrates, calcium channel blockers, intravenous prostaglandins, surgery

• Raynauld's phenomenon (Patient.info)