A 39-year-old African-American woman comes to see you in the office with complaints of left shoulder pain for the past two months. She describes the pain as a dull constant ache which gets worse whenever she reaches over her head with her left arm. She denies any recent or remote history of trauma or falls. There is no weakness or loss in the range of motion of the shoulder joint. You do a thorough musculoskeletal examination of both her shoulder joints, and conclude that she is suffering from rotator cuff tendonitis. Which of the following pain patterns will most likely support your clinical diagnosis of rotator cuff tendonitis?

Question

A 39-year-old African-American woman comes to see you in the office with complaints of left shoulder pain for the past two months. She describes the pain as a dull constant ache which gets worse whenever she reaches over her head with her left arm. She denies any recent or remote history of trauma or falls. There is no weakness or loss in the range of motion of the shoulder joint. You do a thorough musculoskeletal examination of both her shoulder joints, and conclude that she is suffering from rotator cuff tendonitis. Which of the following pain patterns will most likely support your clinical diagnosis of rotator cuff tendonitis?

Quizplus · Accepted Answer

Explanation: Shoulder pain is a common musculoskeletal problem encountered in primary care practice. A careful history and physical examination can determine the cause of shoulder pain in the majority of patients. Most of the patients presenting with shoulder pain have an intrinsic shoulder disorder. Lateral shoulder or deltoid pain aggravated by reaching or lifting the arms up is the classic pattern of pain seen in patients with rotator cuff tendonitis or tear, impingement syndrome, and frozen shoulder. Rotator cuff tendonitis and tear are the two most common causes of chronic shoulder pain in middle-aged and older patients. A rotator cuff tear is likely if the pain is accompanied by weakness or loss of strength during external rotation or abduction of the shoulder. Frozen shoulder refers to a stiffened glenohumeral joint, and is most commonly caused by rotator cuff tendonitis. It is suspected when the lateral pain pattern is accompanied by stiffness and a decreased range of motion in abduction and external rotation. (Choice A) Anterior shoulder pain is seen in patients with acromioclavicular or glenohumeral joint osteoarthritis and biceps tendonitis. This pain pattern is seen less frequently than lateral deltoid pain. (Choice B) Posterior shoulder pain is the least common pain pattern, and is usually a referred pain from the cervical spine. The common causes are nerve impingement due to disc herniation, and spinal stenosis at the cervical spine level. (Choice D) Axillary pain is not a classic pain pattern for any of the common shoulder disorders. It may be caused by an external trauma or extensive rotator cuff disease. (Choice E) Poorly localized pain is usually due to referred pain from the neck, bony structures, or nerve compression. Educational Objective: Rotator cuff tendonitis usually manifests as lateral shoulder pain aggravated by movements requiring abduction and external rotation of the shoulder. abduction and external rotation

A 39-Year-Old African-American Woman Comes to See You in the Office