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  #1  
Old 08-20-2011
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Rheumatology/Orthopedics Severe shoulder and arm pain

A 63-year-old painter complains of severe right shoulder pain. The pain is located posteriorly over the scapula. These symptoms began after he fell from a ladder 2 weeks ago. The pain is especially bad at night and makes it difficult for him to sleep. In addition, he has had some pain in the right upper arm. Treatment with acetaminophen and ibuprofen has been unsuccessful in controlling his pain. On examination the patient appears uncomfortable. The right shoulder has full range of motion. Movement of the shoulder is not painful. There is no tenderness to palpation of the scapula. What is the most likely diagnosis?

A Subdeltoid bursitis
B Rotator cuff tendonitis
C Adhesive capsulitis
D Osteoarthritis
E Cervical radiculopathy
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  #2  
Old 08-20-2011
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the answer is B
give lidocaine in the joint
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Old 08-20-2011
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i will also go with B
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Old 08-20-2011
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i'l go with A
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Old 08-20-2011
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Correct answer is E.
Shoulder pain may be caused by inflammation of tendons or muscles in the shoulder girdle, intra-articular problems at the glenohumeral joint, or referred pain from a cervical radiculopathy. Posterior shoulder pain and a normal shoulder examination are clues to the correct diagnosis in this patient. The pain of cervical radiculopathy is often severe and worse at night. Extension of pain into the arm may occur, but this also occurs with other etiologies of shoulder pain. Shoulder pain is common, particularly in the elderly. Subdeltoid bursitis causes exquisite local tenderness. Rotator cuff tendonitis is frequently associated with pain on active but not passive movement of the joint. Weakness of the arm suggests rotator cuff tear. In adhesive capsulitis, range of motion is restricted. Crepitance on manipulation of the shoulder suggests osteoarthritis of the glenohumoral joint.
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