Red flags useful to screen for gastrointestinal and hepatic diseases in patients with shoulder pain: A scoping review.
Level 4 - case-series / case-control
Scoping review consisting primarily of case reports (n=37) and retrospective studies (n=2).
PubMed 35229444 · doi:10.1002/msc.1628
What was done
Authors conducted a scoping review across five databases up to May 31, 2021, plus grey literature and reference lists, without language, time, or geographic restrictions. Eligible studies included any design reporting red flags for gastrointestinal and hepatic disorders in patients presenting with shoulder pain.
What was found
From 157 identified records, 40 studies met inclusion criteria: 37 case reports, 2 retrospective studies, and 1 systematic review with meta-analysis. Abdominal pain (14 cases) and abdominal discomfort (3 cases) were the most prevalent red flags, reported in 47% of patients. Common comorbidities were hepato-gastric, cardiac, visceral, and systemic conditions. Abdominal, epigastric, and right and left hypochondriac pain were the primary visceral symptoms mimicking shoulder pathology.
Why it matters
Shoulder pain frequently stems from neuromusculoskeletal origins, but referred visceral pain can lead to misdiagnosis or delayed treatment. Screening for concurrent abdominal and hypochondriac pain provides an important clinical clue for non-musculoskeletal causes.
Limits
The underlying evidence base is overwhelmingly anecdotal, relying almost entirely on isolated case reports (37 of 40 studies). Diagnostic accuracy metrics (sensitivity, specificity, positive predictive value) of these red flags were not determined.