A Complicated Case Of Left Shoulder Pain - Page #1

Author: Jenna Walls, MD
Co Author #1: Catherine Reese, MD
Co Author #2: Tim Von Fange, MD

Patient Presentation:
A 53-y.o. female presents with a six-month history of left shoulder pain that began after she reached directly to the back seat behind her, while riding as the passenger in a car. She experienced an immediate sharp pain in her shoulder, and has had ongoing pain and weakness in her left shoulder since the injury. The patient has received an injection in her shoulder, has completed several physical therapy visits, and has taken NSAIDs with no improvement in her symptoms. She denies any prior history of similar shoulder pain or previous injury.

ROS: Positive only for left shoulder pain. No swelling or numbness. Denies fevers, weight loss, or fatigue.

PMHx: GERD, stress incontinence, lower extremity varicosities, lumbar radiculopathy
Social: never a smoker
Surgeries: hysteroscopic ablation, hernia repair
Meds: Flonase, Singulair, Voltaren gel, Loratadine, Omeprazole, Naproxen
Family Hx: HTN, heart disease, cancer (breast, ovary, prostate)

Physical Exam:
-Left shoulder: TTP over the supraspinatus and infraspinatus tendon insertion sites.
AROM with limited forward flexion (130 degrees), abduction (110), internal rotation (to glute), and external rotation (30).
Positive Hawkins test.
Strength 4/5 and painful in abduction and external rotation.
- Cervical Spine: Full AROM in flexion and extension with minimal symptoms.
Lateral flexion causes stretch discomfort only.
Spurling's to the right does cause some pain down the left arm to the elbow.

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