You are examining the patient who complains of right anterior shoulder pain. There is full range of motion with a painful arc on elevation and depression at approximately 50° on both the upswing and the downswing, but no muscle wasting is observed. Palpation yields tenderness over the bicipital groove. The past medical history includes generalized arthritis and occasional bouts of gout. Muscle strength is good throughout except for right forearm supination, which is decreased to good minus, and elbow flexion is graded as good. Shoulder abduction in either direction of glenohumeral rotation is painful, and resisted flexion with the forearm fully pronated is mildly uncomfortable, whereas resisted flexion and supination is definitely painful. Palpation yields tenderness over the bicipital groove. The special tests revealed a negative Yergason’s test, positive impingement sign, and positive Speed’s test. Given this information, which of the following would be your most likely working hypothesis?

1. Anterior shoulder instability
2. Glenoid labrum tear
3. Bicipital tendinopathy
4. Coracoid impingement syndrome

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