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Alright, so let's just review one last case to review some of the stuff that we'd been talking
about. So, this one is a 63-year-old woman with no significant past medical history who presents
with increasing right shoulder pain over the past 2 or 3 months. She is a regular swimmer and
reports increasing discomfort with her freestyle stroke when she is reaching her right arm out
in front of her. Her pain is anterolateral in location and is exacerbated by reaching overhead,
which creates a popping sensation. She also reports lateral arm pain at night especially when
she lies on her right side. Now, gross inspection is within normal limits. Palpation of landmarks
highlights some point tenderness over the acromiohumeral sulcus. Active range of motion is
pain limited to about 90 degrees of abduction and external rotation. Passive range of motion is
appropriate for her age, but the patient does have a positive painful arc between 60-120 degrees of
abduction. Strength testing is normal and her Speed's test is negative. Alright. So let's go and
take a specific look at some of these features of this case. So first up, her pain is anterolateral
in location. Now that's pretty typical for rotator cuff disease. You can have rotator cuff
disease, biceps tendinopathy which would also be anterolateral in location or potentially disease
of the acromioclavicular joint though that tends to be more on the top of the shoulder. Importantly,
if a patient complains of posterior shoulder pain you should be thinking more about neck pathology
like cervical radiculopathy. Next up, she says she has a popping sensation and that's something
you might also see with any instability of the glenohumeral joint either due to rotator cuff disease
or a glenoid labral tear. She has lateral arm pain at night and that is one of the textbook
features that you'll see for a patient who's reporting rotator cuff tendinopathy. The pain is on
the lateral aspect and it's more uncomfortable in the evening. We talked about point tenderness
of the acromiohumeral sulcus. That is essentially the little concavity that's formed by tugging
down on the shoulder. It's basically where the humerus ends and the acromion begins and it
basically indicates tenderness over the supraspinatus tendon. Lastly, the painful arc is a test
that helps to suggest that there is disease of the rotator cuff and most commonly tendinopathy since
she did not have a drop arm test. Alright, with all that information, let's look at our table as
well. So, shoulder pain she does have, looking at our column for our patient all the way in the
far right. She does not have stiffness, she does not have weakness, she does have a painful
arc as I said but no drop arm test. She has normal range of motion passively and a negative
Speed's test. So, trying to compare her column with another column in our table, it looks like
she's got rotator cuff tendinosis. And that's it for the shoulder exam.