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Lurking In The Acoustic Shadows: Uncovering An Uncommon Diagnosis With Ultrasound - Page #1
 

Author: Natalie Cignetti, MD
Co Author #1: Elizabeth Bautista-Whitaker, DO
Co Author #2: Antonio Howard, MD
Senior Editor: Kristine Karlson, MD, FAMSSM
Editor: Jeffrey Mjaanes, MD

Patient Presentation:
A 45-year-old male presented for evaluation of left shoulder pain.

History:
The patient reported his left shoulder pain started eight weeks ago after performing manual labor at work in construction. He described the pain as dull/aching at rest, sharp with movement such as overhead activity, and worse at night. He had already seen multiple providers for this pain. He was seen in the Emergency Department (ED) days after pain onset and underwent shoulder radiographs which were normal. In the ED he was diagnosed with rotator cuff tendonitis and recommended to rest, ice, and utilize anti-inflammatories. Despite these interventions, his pain did not improve. One month later, he was evaluated in our sports medicine clinic. He was noted to have new limitations in active and passive range of motion. He was diagnosed with adhesive capsulitis and referred to physical therapy. On follow-up 8 weeks later, his pain had continued to worsen, and he complained of a new electric pain radiating down his arm at night, often interfering with his sleep.

Physical Exam:
Mild decrease in muscle bulk of the left deltoid and biceps muscles. Tenderness to palpation over the humeral head. Decreased active and passive range of motion with internal and external rotation. Normal cervical range of motion. Normal sensation. Mild weakness with resisted external rotation; otherwise strength is intact. Pain at end range of Hawkin's test. Negative empty can test. Negative spurling's test.

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, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.
 

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