Origin and causes of shoulder problems The shoulder is the most movable joint in the body. However, it is an unstable joint because of the range of motion allowed. It is easily subject to injury because the ball of the upper arm is larger than the shoulder socket that holds it. To remain stable, the shoulder must be anchored by its muscles, tendons, and ligaments. Some shoulder problems arise from the disruption of these soft tissues as a result of injury or from overuse or underuse of the shoulder. Other problems arise from a degenerative process in which tissues break down and no longer function well. Shoulder pain may be localized or may be referred to areas around the shoulder or down the arm. Disease within the body (such as gallbladder, liver, or heart disease, or disease of the cervical spine of the neck) also may generate pain that travels along nerves to the shoulder. [edit] How shoulder problems are diagnosed Following are some of the ways doctors diagnose shoulder problems: Medical history (the patient tells the doctor about an injury or other condition that might be causing the pain). Physical examination to feel for injury and discover the limits of movement, location of pain, and extent of joint instability. Tests to confirm the diagnosis of certain conditions. Some of these tests include: x ray arthrogram--Diagnostic record that can be seen on an x ray after injection of a contrast fluid into the shoulder joint to outline structures such as the rotator cuff. In disease or injury, this contrast fluid may either leak into an area where it does not belong, indicating a tear or opening, or be blocked from entering an area where there normally is an opening. MRI (magnetic resonance imaging)--A non-invasive procedure in which a machine produces a series of cross-sectional images of the shoulder. Other diagnostic tests, such as injection of an anesthetic into and around the shoulder joint, are discussed in specific sections of this booklet.