You are examining a 45-year-old left-hand dominant female who presents with gradual onset of left shoulder pain that started approximately six months ago without an apparent cause. The patient rates her pain at 6/10 and describes it as a dull ache that radiates from her shoulder to the posterior aspect of the forearm and that it increases with motion and decreases with rest. The patient reports no history of left shoulder problems but states that she had right shoulder bursitis approximately 10 years ago, which was resolved with cortisone injections. Because of the previous success of the cortisone injections, the patient asked her doctor for similar treatment and subsequently had two cortisone shots to her left shoulder over the last three months but with no success. Otherwise, the patient’s medical history is unremarkable.
Your physical examination reveals mild kyphosis due to rounded shoulders and a forward head. The left scapula is 1 inch higher than the right, and the scapulothoracic rhythm is asynchronous, with the left side moving considerably less than more slowly. The patient’s cervical range of motion is within normal limits except for a feeling of tightness of the left neck during right side bending. The range of motion and strength of the right upper extremity are within normal limits, but the left glenohumeral joint AROM is as follows: flexion at 95°, abduction at 60°, external rotation at 25°, and internal rotation at 70°, all of which are accompanied by pain but especially painful with external rotation. PROM increases only 5° in each direction with increased pain. Manual muscle testing of the left shoulder revealed 3+/5 with all shoulder girdle muscles except the external rotators, which scored 3/5. There were no positive findings with the neurologic tests, and the impingement sign, drop arm test, and supraspinatus sign were negative. Accessory joint motion testing revealed grade II hypomobility throughout, especially in the anterior and inferior directions.
Given the findings thus far, what would be your provisional diagnosis?
- Subacromial bursitis
- Muscle strain of the deltoid
- Adhesive capsulitis
- Double crush syndrome
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