Introduction In most patients, shoulder pain has a neuromusculoskeletal cause. However, it might conceal other types of disorders, hiding a non‐neuromusculoskeletal condition. The main aim of this scoping review is to map and summarise findings to identify red flags for gastrointestinal and hepatic diseases in the assessment of patients with shoulder pain. Methods Five databases were searched up to 31 May 2021. Additional studies have been identified through grey literature, and the reference lists of the included studies have been screened. Any study design and publication type have been considered to be eligible for inclusion. No time, geographical setting and language restrictions have been applied. Results A total of 157 records have been identified, with 40 studies meeting the inclusion criteria (37 case reports, 2 retrospective studies and 1 systematic review with meta‐analysis). The most prevalent red flags associated with shoulder pain were abdominal pain (14 cases) and abdominal discomfort (3 cases), reported by 47% of patients. As for comorbidities, hepato‐gastric, cardiac, visceral and systemic diseases were the most common ones. Conclusion Abdominal pain, right and left hypochondriac pain, and epigastric pain represent the most prevalent symptoms in patients with an abdominal disease that could mimic a shoulder problem. Clinicians should be encouraged to screen for red flags when assessing patients with shoulder pain.

Background. Lateral Elbow Tendinopathy (aka Tennis Elbow or Lateral Elbow Pain), is characterized by a specific pain located in the lateral epicondyle and referred to the dorsal compartment of the forearm. Manual labour and forceful gripping activities can exacerbate pain, by restricting a patient's ability to work, train and perform simple daily tasks. In the framework of an aetiopathogenic complexity, a multimodal approach based upon the exclusive involvement of the common extensor tendon seems to be rather obsolete. This method does not consider any intra-articular pain resulting from micro-instabilities requiring a different approach together with a detection performed in a limited time span, in order to avoid any impairment of the psychosocial condition following the failure of all the proposed conservative treatments. Objectives. The primary objective of this debate was to have elaborated a decisional algorithm called Integrated Approach of Lateral Elbow Pain (I-APPLEp), which could allow the detection of a time-optimized plan for a diagnostic, therapeutic framing. Discussion. Following the above-mentioned research proposal, this clinical approach based upon an evaluative and therapeutic management of patients with LEP allows us to draw some conclusions: 1) using the expression Lateral Elbow Pain (LEP) to refer to this musculoskeletal condition should be preferable, owing to its aetiological and pathophysiological complexity. Moreover, the expression Non-specific Lateral Elbow Pain (NSLEP) in case of suffering of the extra-articular structures (i.e. Tendinopathy) and Specific Lateral Elbow Pain (SLEP) is recommended, within the framework of arthropathy or intra-articular pathology (e.g.: Smile Symptomatic MInor Instabilities of the Lateral Elbpw); 2) an early surgical treatment can be a feasible option in the management of articular micro-instabilities, recalcitrant pathologies and psychosocial profiles with a high risk of unfavorable prognosis. Conclusions. We recommend testing brand-new diagnostic, therapeutic proposals on sampling patients, who must be adequately chosen, in order to estimate the real impact in the short, medium and long term.

Background The Shoulder and Pain Disability Index (SPADI) is a widely used outcome measure. The aim of this study is to explore the reliability and validity of SPADI in a sample of patients with idiopathic frozen shoulder. Methods The SPADI was administered to 124 patients with idiopathic frozen shoulder. A sub-group of 29 patients were retested after 7 days. SPADI scores were correlated with other outcome measures (i.e., Disabilities of the Arm, Shoulder and Hand Questionnaire – DASH; Numerical Pain Rating Scale—NPRS; and 36-item Short Form Health Survey—SF-36) to examine construct validity. Structural validity was assessed by a Two-Factors Confirmatory Factor Analysis (CFA). Internal consistency, test–retest reliability, and measurement error were also analyzed. Results The construct validity was satisfactory as seven out of eight of the expected correlations formulated (≥ 75%) for the subscales were satisfied. The CFA showed good values of all indicators for both Pain and Disability subscales (Comparative Fit Index = 0.999; Tucker-Lewis Index = 0.997; Root Mean Square Error of Approximation = 0.030). Internal consistency was good for pain (α = 0.859) and disability (α = 0.895) subscales. High test–retest reliability (Intraclass correlation coefficient [ICC]) was found for pain (ICC = 0.989 [95% Confidence Interval (CI = 0.975–0.995]) and disability (ICC = 0.990 [95% CI = 0.988–0.998]). Standard Error of Measurement values of 2.27 and 2.32 and Minimal Detectable Change values of 6.27 and 6.25 were calculated for pain and disability subscales, respectively. Conclusion The SPADI demonstrated satisfactory reliability and validity properties in a sample of patients with idiopathic frozen shoulder.

Osteoid osteoma (OO) is a relatively common, benign bone-forming tumour, which mainly occurs on the long tubular bones of the limbs in adolescents. Usually, the OO is classified based on its localisation. Night-time pain is the major symptom of OO, which is commonly relieved using non-steroidal anti-inflammatory drugs, while surgery is required only for those patients with severe pain or in case of failure of previous conservative treatments. Our case report describes a 56-year-old male basketball player who self-referred to our outpatient physical therapy with a shoulder pain complaint. Considering the anamnesis and the physical examination, the physical therapist referred the patient to an orthopaedic surgeon, who suggested a detailed imaging investigation. The peculiarity of this clinical case is the overlapping of two clinical presentations: the symptomatology of the OO and the concurrent mechanical disorder due to a rotator cuff tendinopathy.

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Shoulder pain (SP) is the third most common musculoskeletal disorder worldwide and its prevalence ranges from 5 to 47%. However, the clinical presentation of signs and symptoms may hide other serious conditions; the so-called Red Flags (RFs). For these reasons, clinicians dealing with neuro-musculoskeletal shoulder disorders should pay particular attention during the medical history and clinical examination screening and identifying signs that may cause probable referred symptoms. Considering the variety of clinical presentations of SP and the importance of the screening for referral, identifying and summarizing the possible gastrointestinal and hepatic diseases among these patients may give a comprehensive overview to the clinicians and consequently may improve the overall management. To the authors knowledge, there are no published studies on the topic and, in this context, a scoping review is strongly required and corresponded to the objectives of this project.