You are examining a 54-year-old male who presented himself with sudden pain and loss of function in the right shoulder four days ago. The patient cannot recall any injury. The symptoms began a week ago when he painted three ceilings in his house with his dominant right arm. The pain in the anterolateral arm over the areas of the middle and upper deltoid muscle bellies has increased over the last four days, and the shoulder is held away from the body in approximately 30 to 40° of abduction.

Upon palpation, there is tenderness over the bicipital groove and the rotator cuff tendons, but particularly beneath the right acromion process. Active and passive elevation is painful at 50° with an empty end feel, but rotation in either direction is painless. Abduction is more limited than forward flexion. Muscle strength of the right shoulder musculature is in the fair plus range but only becomes painful when being tested through the 50 agreed to 130° range of elevation. Both the drop arm test and positive impingement sign are negative. Based on this information, what would your working hypothesis be?

1. Subacromial bursitis
2. Bicipital tendinopathy
3. Supraspinatus impingement
4. Inflammatory arthritis

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