Painful Shoulder

A painful shoulder.

Diagnosis: Clostridium perfringens septic arthritis. Although the initial Gram stain of the sample of purulent material obtained from the patient’s shoulder (figure 1) revealed only rare gram-variable rods with no neutrophils, the culture eventually grew C. perfringens. The “double zone” of hemolysis seen in figure 2 is very characteristic of C. perfringens. The zone of partial hemolysis is due...

The Painful Shoulder

PAIN in the shoulder may result from lesions of a gross nature, such as fractures, dislocations, tuberculosis, bone tumours, and infective arthritis, and may also be due to conditions of the cervical spine, the neck, the apex of the lung and pleura, and obstruction of the cervico-axillary outlet. As well as this, pain may be felt in the shoulder from visceral disturbance, notably from heart and...

The painful shoulder.

Painful Hemiplegic Shoulder

Shoulder pain resulting from hemiplegia is a common clinical consequence of a focal cerebral insult resulting from a vascular lesion (ie. hemorrhagic or ischemic stroke). Painful hemiplegic shoulder can occur as early as 2 weeks post stroke but an onset time of 2-3 months post stroke is more typical. Shoulder pain can negatively affect rehabilitation outcomes as good shoulder function is a prer...

The painful shoulder: can consultants agree?

As a two-phase exercise in inter-district audit, with the emphasis on critical evaluation of routine clinical practice, three rheumatologists each examined the same 44 patients with shoulder pain, and recorded their diagnosis and the investigations and treatment they would carry out. In the first phase, 26 patients were seen by each rheumatologist separately; there was complete diagnostic agree...