Quesions for Discussion with answers:

  1. List potential anatomic sources of shoulder pain.  Answer

The pain is described as dull, non-radiating and occurs with abduction of the shoulder. There is no pain at rest. The patient first noticed the pain after painting a room in his house. The pain has become more severe over the past few days. He now feels as if he will drop objects when lifted.

There is no numbness or tingling of the arm. Pain is not pleuritic. On review of systems he has no weight loss, fever, shortness of breath, chest or abdominal pain.

  1. What is the most likely diagnosis now?  Answer
  2. What components of the physical exam will assist you in making a diagnosis?  Answer

On PE the shoulder is not swollen. Passive ROM is normal. Active ROM is limited at 60E of abduction by pain. There is a positive impingement sign. Sensation, motor strength and reflexes are normal. Examination of the heart, lungs and abdomen are unremarkable

  1. What is the likely diagnosis? Answer
  2. What tests are necessary to confirm the diagnosis?  Answer
  3. What management options are available?  Answer