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Workup Of Progressive Shoulder Pain Leading To The Diagnosis Of A Lytic Bone Lesion - Page #1
 

Author: Donald Dangle, DO
Co Author #1: Michael Cordas, Jr.
Editor: Poonam Thaker, MD
Senior Editor: Poonam P. Thaker, MD

Patient Presentation:
62-year-old gentleman presented for evaluation of two month history of left shoulder pain with associated decreased range of motion. He initially had been seen by his primary care physician and was given a steroid injection to the left shoulder, but reports that it did not help. He denied any specific injury or trauma. His pain was described as achy, constant, and worsened with movement. He had been taking oxycodone for pain, which only helped minimally. He had also tried some physical therapy but was unable to continue due to pain. He denied any neck pain or any numbness and tingling.

History:
Past medical history includes obstructive sleep apnea, diabetes, stroke, depression, anxiety, arthritis, polycythemia, atrial fibrillation, and a history of kidney stones.

Past surgical history includes two left knee surgeries, left wrist surgery, and back surgery.

Family history is positive for heart disease in father, who is deceased. Mother and siblings are living and in good health.

Social history - Patient is retired, divorced, disabled, and lives by himself. He smokes 3-4 packs per day for past 50 years and uses alcohol 1-2 times per week. He denies any drug use.

Patient has no known drug allergies.

Medications include Metformin, Glimepiride, Prozac, and Lorazepam.

Physical Exam:
VS - Height 6 feet, Weight 244 lbs, BP 122/78 mmHg, P 72 bpm
General - No acute distress
Skin - Warm and dry with no suspicious lesions noted
HEENT - Normocephalic, Pupils equal, round, and reactive to light
Neck - Supple, no jugular venous distention
CV - Regular rate and rhythm
Pulm - Clear to auscultation bilaterally
Abd - Soft, non-distended, non-tender
Left shoulder - No gross deformity, erythema, or swelling; significantly decreased range of motion with abduction/flexion to 90 degrees, unable to passively flex due to pain; (+)Empty can, Neer, Hawkins, and O'Brien tests causing anterolateral discomfort.
Other MS - Range of motion right shoulder normal; muscle strength testing 4-5/5 all muscle groups bilateral upper extremities.
Neuro - Awake, alert, and oriented x 3, sensation intact.

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.


NOTE: For more information, please contact the AMSSM, 11639 Earnshaw, Overland Park, KS 66210, (913) 327-1415.
 

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