Recognition of pulmonary pathology in a patient presenting with shoulder pain

Fabrizio Brindisino, Valerio Passudetti, Denis Pennella, Giuseppe Giovannico, John D. Heick

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Background. Shoulder pain is a common symptom of musculoskeletal disorder about the shoulder. However, shoulder pain can also be symptomatic of other non- musculoskeletal disease. Careful assessment of the clinical presentation is essential in differential diagnosis and decisions to treat or refer. Case Description. A 56-year-old male preseted with shoulder pain and a previous diagnosis of subacromial impingement of the left shoulder. The shoulder pain increased with effort, was present at night making it difficult to sleep and became disabling for the patient in work and activities of daily living. In addition, the patient reported left thoracic pain and increasing episodes of dry coughing, shortness of breath, fever and unusual generalized fatigue. Physical examination did not reveal a musculoskeletal concern about the patient’s shoulder. An increased body temperature was detected and when combined with auscultation and thorax percussion led the physiotherapist to hypothesize pulmonary involvement, later reinforced by the evocation of the patient’s symptoms while measuring his peak expiratory flow. Discussion. An underlyng serious pathology can be easily masked by shoulder pain. Physiotherapists need to consider that when a patient presents with a cluster of history and physical examination findings that are negative for mechanical shoulder pain, other systems must be considered as the source of presenting symptoms. Through the identification of risk factors and red flag findings, the physiotherapist can identify the need for referral.

Original languageEnglish (US)
Pages (from-to)597-607
Number of pages11
JournalPhysiotherapy Theory and Practice
Issue number4
StatePublished - 2022


  • Differential Diagnosis
  • Red Flags
  • Shoulder Pain
  • pleurisy

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation


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