Shoulder Pain: Rotator Cuff Tear Or Worse?

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Shoulder Pain: Rotator Cuff Tear Or Worse? - Page #1

Author: Michael Brackman, DO Co Author #1: Marri Brackman, D.O. Scott & White Memorial Hospital Family Medicine Residency Temple, Texas Co Author #2: Marri Brackman, D.O. Scott & White Memorial Hospital Family Medicine Residency Temple, Texas Co Author #3: Marri Brackman, D.O. Scott & White Memorial Hospital Family Medicine Residency Temple, Texas Patient Presentation: 45 year-old caucasian male presented with right shoulder pain and weakness. History: Six months earlier, he awoke from sleep with sudden onset of a burning sensation in his right shoulder that did not radiate down his arm or into his neck. The pain was severe enough to send him to the emergency department that night, where he was given a diagnosis of acute rotator cuff tear and sent home with pain medications. Over the next month, his shoulder pain resolved and no longer required pain medication; however, his shoulder progressively weakened to the point that he was unable to perform his job as a handyman. His medical history was significant for human immunodeficiency virus diagnosed one year ago and recent treatment for Pneumocystis Jiroveci pneumonia. Social history was positive for previous intravenous drug use that he stopped twenty years ago. Physical Exam: His right shoulder showed wasting of the supraspinatus, infraspinatus, and deltoid muscles. Case Photo #1 , Case Photo #2 No winging of the scapula was noted. Active range of motion was limited to 60 degrees of abduction and 70 degress of forward flexion with normal passive range of motion. Reflexes were normal throughout the upper extremities and pulses were intact distally. Special tests for rotator cuff were not documented. His cervical spine had normal range of motion. Left shoulder exam was unremarkable. He was right handed. Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.		Back
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