Referred pain should be considered in all patients who complain of shoulder pain. It is usually unaffected by moving the arm, and may be associated with symptoms or signs elsewhere in the body.
The most common cause of referred shoulder pain is cervical spondylosis, but other causes such as an apical lung tumour, or a cause of diaphragmatic irritation such as a subphrenic abscess or gallbladder disease should be considered. Mediastinal pathology, such as ischaemic heart disease, should also be excluded.
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