Step 2: Examination

Examination shows a reduced range of movement of the right shoulder, with a 30 degree loss of abduction and a 20 degree loss of external rotation to passive and active movement. The shoulder joint itself is a little tender but you don’t notice any mass, swelling or effusion on your this exam. There is little else to find, he is a fit and well 52 year man.

Prior to ordering your investigations, what is your differential diagnosis at this point?

Adhesive Capsulitis (“Frozen Shoulder”) would certainly be at the top of my list. It can be precipitated by a minor trauma and persist for 18-24 months. The loss of external rotation is common. I would also consider osteoarthritis as a cause of loss of range of movement. Other possibilities would include an unrecognized fracture that has gone on to heal or an injury to the rotator cuff.

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