Q: I am a 32 year old female with a history of hypertension and hypothyroidism and have been taking Amlopin 5 mg and 100 mg. I am suffering from shoulder girdle pain for last 3 months and have got the X-Ray done, which shows normal spine and shoulder. I want to know the causes for my problem.

A:Shoulder girdle comprises of scapula, clavicle and humerus (arm bone). To understand the cause of the pain in the shoulder, you should be aware of the various structures around the shoulder joint. The joint is formed by the head of the humerus and glenoid cavity of the scapula. It is stabilized by contributions from 4 muscles, which make the rotator cuff. This rotator cuff lies beneath the bony acromion process of the scapula. Between the acromion process and the rotator cuff is a cushion (bursa), called subacromial bursa. Then there are muscles around the joint like the biceps and deltiod. Either the pain can be from the shoulder joint, or it can be from the cervical spine or it can be referred pain of any visceral origin, like due to cardiac causes. The xrays of the spine and the shoulder are normal, but i hope the whole series of xrays is considered. There can be instances when a single view of the shoulder can miss an appropriate diagnosis. Given that the xrays are normal, the soft tissues must be the source of the pain. Pain can arise because of the impingement of the acromion process of the scapula on the underlying rotator cuff. This is called impingement syndrome. The other cause can be a rotator cuff tear. The pain can also be due to inflammation of a muscle or a tendon, like biceps tendinitis. The pain can be because of a whiplash injury to the neck, which may show normal xrays and mri. or the pain may be neurological. The pain may be due to inflammation of the bursa, like subacromial bursitis. There can be other possibilities but these are the commonest in a young, otherwise healthy person.