Shoulder Pain and Stiffness with Abnormal Imaging Findings
Am Fam Physician. 2020 Dec 1;102(11):695-696.
A 51-year-old patient presented with several years of diffuse pain in the right shoulder. The pain, which the patient rated as 10 out of 10 on a pain scale, was exacerbated by any activity. The patient reported shoulder stiffness and subjective weakness in the arm. The patient had no history of injury or surgery to the shoulder but had undergone bilateral hip replacements and right ankle fusion. The patient had a history of type 2 diabetes mellitus and hypertension.
On physical examination, the patient's right shoulder was diffusely tender and mildly warm. The range of motion was significantly decreased in all planes. Rotator cuff strength could not be evaluated because of pain. Results of the Hawkins and Neer impingement tests, empty can test, lift off test, and drop arm test were grossly positive. The patient could not tolerate further testing because of pain. Shoulder radiography (anteroposterior view; Figure 1) and magnetic resonance imaging (T2 frontal view; Figure 2) were performed.
Based on the patient's history, physical examination, and imaging findings, which one of the following is the most likely diagnosis?
A. Adhesive capsulitis.
B. Inflammatory arthritis.
C. Rotator cuff tear.
D. Synovial chondromatosis.
The answer is B: inflammatory arthritis. Inflammatory arthritis encompasses multiple conditions that are categorized as autoimmune connective tissue disease (e.g., rheumatoid arthritis, systemic lupus erythematosus, vasculitis), spondyloarthritis (e.g., ankylosing spondylitis, psoriatic arthritis, reactive arthritis, inflammatory bowel disease–related arthritis), infectious arthritis (e.g., bacterial, viral), and crystal arthritis (e.g., gout, calcium pyrophosphate deposition disease).1
Large erosions on radiography and magnetic resonance imaging (MRI) can be typical findings in patients with rheumatoid arthritis, psoriatic arthritis, and gout. This patient's MRI demonstrates a large glenohumeral joint effusion that contains multiple
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This series is coordinated by John E. Delzell Jr., MD, MSPH, associate medical editor.
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