Not Your Bread And Butter Shoulder Pain - Page #1

Author: Fouad Sayde, MD
Co Author #1: Fouad Sayde, MD (Primary Author/Presenter)
Co Author #2: Eric Makhni, MD

Patient Presentation:
50 year old healthy male presents with right shoulder pain. Symptoms began 2 months ago, after a gym workout where he tried a new machine (chest fly). Three days later, started having achy right shoulder pain located in the lateral and superior shoulder. Pain was nonradiating. 2/10 at rest; 7/10 with activity (worse with bench press, overhead activities, and sleeping on affected shoulder); 8/10 at night. No neck pain, radicular symptoms, paresthesia, numbness, or tingling. Continued to go to the gym but reports associated shoulder weakness with overhead lifting. Ibuprofen provides moderate pain relief. Saw his PCP one month ago who prescribed Medrol dose pack, which relieved pain but not weakness.

PMH: none
PSH: left shoulder arthroscopy (2010)
Allergies: none
Meds: Ibuprofen 600 mg PRN

Physical Exam:
BP 103/63, HR 71, BMI 27

Neck: Full ROM; no tenderness; negative Spurling

Right Shoulder:
Inspection- no deformities, swelling, or erythema
ROM- FF 170/170, abduction 170, ER 45 (left 45), IR T10 (left T9)
Neers positive
Hawkins positive
Cross body negative
Obrien negative
Speeds negative
Strength: Supraspinatus 4+/5; Infraspinatus 4+/5; Subscap 5/5; Champagne toast 4/5; Belly press, liftoff, and lag signs negative; Deltoid 3 heads intact and 5/5
Sensation intact in axillary, radial, median, and ulnar distribution
Distal pulses intact

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