Step 1: Chondrosarcoma
A 52 year old man presented to an orthopaedic surgeon due to the pain he was having in his right shoulder. He had initially hurt it while surfing, but the pain was still persisting 18 months later.
Pain persisting for this long after a minor injury is already suspicious that there is more going on. It will be important to ask him about the nature of the pain, the exact location and any radiation. Does he have pain elsewhere? Perhaps the pain isn’t even coming form his shoulder but is related to a neck injury? It will also be important to detail the exact mechanism of injury, was it a major crash or just a tumble in the smaller waves?
You go on to complete the history. There is no reported neck pain or stiffness, and there are no other associated symptoms such as numbness or paraesthesia in the upper limb.
The medications he takes for the pain can be a guide to the severity. It is also important to know how much this is affecting his life – can he work? Can he play sports? I often ask “Can you still do all the things you want to?” It will also be important to know what treatments he has undertaken such as physiotherapy or any surgery.
He tells you he has not had to take any time off his work as an accountant, but he has not gone back to full activity. He has had some physio on and off, and some anti-inflammatories but little else. He has had no surgery or other interventions.