Shoulder being a complex of 5 joints and overlay of cardiac and cervical pain makes the diagnosis a challenge. Cardiac pain starts from the Left side of the chest, radiates to an inner side of the arm, (distribution in C7, 8-T1). Cervical spine pain radiates below the elbow to fingers, a patient is better in lying down position, trapezial irritation is present, Spurling sign is positive & neurological signs may be present. Shoulder pain gets referred to an outer side of the upper arm, the distribution being the same as in cervical pain but in contrast, it increases on lying down (increasing even more in the night) and is better in sitting posture.


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