肩关节周围疼痛很常见，以前由于认识不足，常被归为“肩周炎”，其实并非如此。

　　肩关节的疾病也是多种多样，肩周疼痛的位置对于判断肩关节病变具有价值。

　　今天主要鉴别  引起肩前疼痛的不同疾病。山东大学第二医院骨外科殷庆丰

　　1. 前方关节线疼痛-- 通常局限，较轻，钝痛，（关节囊炎症，早期冻结肩、肩周炎）--X 线+MRI

　　2. 二头肌间沟-- 通常局限，较轻，钝痛，提重物时疼痛---二头肌腱炎---超声

　　3.前外侧疼痛---通常弥漫，向远端放射痛，过顶运动时剧痛----肩袖病变（撞击，肩袖撕裂，肌腱钙化）

　　4.肩锁关节疼痛---非常特异和局限，钝痛，极度过顶运动可剧痛，肩锁关节炎--老年，骨溶解--青年-“举重肩”

　　5.斜方肌区疼痛---持续钝痛，可放射，不受肩关节活动影响----颈椎病----MRI

　　6.喙突疼痛---少见--局限--内收时疼痛--喙突撞击，也可能是关节囊炎症，关节病变继发表现

　　7.胸锁关节疼痛--局限，较轻，内收，过顶运动疼痛加重---胸锁关节炎

　　anterior join line pain - localised and tender, often aching and dull in nature - consider capsulitis (early frozen shoulder) - x-ray and MRI scan

　　Biceps groove pain - localised and tender, worse with lifting and carrying - consider biceps tendonitis - ultrasound scan

　　Anterolateral pain - diffuse and radiates down arm - aching, but sharp pain with overhead activities (eg. brushing hair) - consider rotator cuff pathology (impingement, tendon tear, calcific tendonitis) - ultrasound scan

　　AC Joint pain - very specific and localised - dull ache, but sharp with extreme overhead activities - consider ACJ Arthritis in older, osteolysis in younger - x-ray and MRI scan

　　Pain over trapezius - persistant, dull ache - can radiate down arm and unaffected by shoulder movements - consider cervical radiculopathy - MRI cervical spine

　　Coracoid pain - rare - localised tenderness over coracoid and sharp pain with shoulder adduction - consider coracoid impingement, but capsulitis may be more likely; also pec minor tightness secondary to other shoulder pathology (eg. impingement, instability) - MRI scan

　　Sternoclavicular join pain - localised and tender, increased with overhead and adduction - consider SCJ arthritis in older, osteitis in young - MRI scan