Chapter 4: Differentiating Bob's Shoulder Pain
Let’s differentiate Bob’s shoulder pain quickly (5 minutes)
For the past two months, a nagging ache had been developing in his left shoulder, but he chalked it up to being out of shape. The pain was dull at first, a persistent throb after a long day of yard work. He could still lift objects, though reaching for something on a high shelf now felt like a chore. ver time, the pain intensified. It began to interrupt his sleep, forcing him to toss and turn throughout the night. The simple act of putting on a jacket or reaching into the back seat of his car became a sharp, burning sensation. His tennis serve, once powerful and effortless, now felt weak and painful. Frustration mounted as he had to sit out games and abandon his beloved garden projects.
No complaints of tingling or numbness. Reflexes 1/2 and symmetrical.
He has no tenderness over his bicep tendon. Moderate spasm left infraspinatus and left rhomboid.
Left shoulder ER and abduction resistance hesitant and tender. His bicep resistance is 5/5.
On exam, Bob is able to lift his arm on his own, but it is tender and tight at end range.
Passive end feel of Bob’s left shoulder is tight and pliable, no hard end.