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Presentation
A 68-year-old man presented to the doctor with complaints of right shoulder pain, joint stiffness, and decreased range of motion that developed over the last 2 months. The patient noted that the shoulder pain feels worse at night when lying down in bed, or with activity. There was no recent history of trauma. He is currently retired but worked a heavy manual labor job for over 45 years. The patient has a medical history of rheumatoid arthritis, and he reported a history of smoking (40+ years). Superior lateral migration of the humeral head was shown through palpation and inspection. External rotation lag sign and lift-off test were positive. An MRI examination demonstrated atrophy of the supraspinatus and infraspinatus muscles with associated rotator cuff tearing. The MRI examination also demonstrated acetabularization of the coracoacromial arch with superior migration of the humeral head and a full-thickness, massive rotator cuff tear. Can you diagnose the patient?
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47% a) Acromioclavicular joint separation
44% b) Adhesive capsulitis of the shoulder
109% c) Rotator cuff arthropathy
55% d) Shoulder impingement syndrome
Learnings
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