Solution to Gradual Onset of Shoulder Symptoms


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The correct answer is C - adhesive capsulitis. The patient exhibits a capsular pattern of motion, with external rotation more limited than abduction, which is more limited than internal rotation, and you know the noncontract tissues are restricted due to passive range of motion testing. Because the cervical range of motion is within normal limits and you can reproduce the patient’s symptoms with shoulder motion, your provisional diagnosis would be an articular joint dysfunction.

Subacromial bursitis could be ruled out as the patient has had two cortisone injections which had previously helped the other shoulder condition

There was no history of trauma, so a muscle strain of the deltoid could be ruled out

there was no evidence of neurologic involvement, so the double crush syndrome could similarly be ruled out

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