Case history
Case history #1
A 50-year-old woman with diabetes presents with a 2-month history of insidious-onset right shoulder pain. She denies a history of shoulder trauma, and has no history of neck pain, arm/hand weakness, or numbness or paraesthesias of the arms/hands. She complains of shoulder pain at extremes of range of motion and has difficulty sleeping on the affected side. She has noticed increasing difficulty with activities of daily living, including brushing her hair, as well as putting on or taking off her blouse and bra. Her examination shows a marked decrease in both active and passive range of motion of the right shoulder; with forward flexion (FF) to 75°, abduction (ABD) to 75°, external rotation (ER) to 15°, and internal rotation (IR) to the iliac crest with pain at extremes of motion. Rotator cuff strength is normal.
Case history #2
A 65-year-old man presents for follow-up 6 months after a mild acromioclavicular sprain that occurred after falling directly onto the left shoulder. He was treated with sling immobilisation for 2 weeks. His acromioclavicular joint pain has completely resolved, but he now complains of shoulder stiffness. He is a construction worker and has noticed difficulty reaching overhead to perform his job over the past several months. Examination shows that he has no tenderness to palpation of the acromioclavicular joint, and has a negative cross arm adduction test. He is severely limited in his range of motion, with FF to 100°, ABD to 80°, ER to 10°, and IR to the iliac crest.
Other presentations
Patients can present with shoulder pain or may be relatively pain-free. Often the cause is idiopathic, but adhesive capsulitis may be associated with a history of diabetes mellitus, thyroid dysfunction, trauma, history of previous shoulder surgery, or periods of immobilisation.
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