Painful

Musculoskeletal System


0

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1

{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M8_F2.jpg"}},{"insert":"\n\n"},{"insert":"A split second before you begin another case, your nurse announces the next patient of the day.\n\nMr. McCoy, a 49 year old retail clerk, has experienced intermittent pain in his left shoulder for the last 6 weeks.\n\nThe pain radiates to the left anterior chest, and is worse at night; there is a noticeable increase in intensity when he stocks the shelves in his workplace.\n\nYou carefully ask if the pain worsens when he exercises or engages in strenuous activity.\n\nHe replies in the negative, but mentions that aside from stocking the shelves, the most strenuous activity he engages in, is walking from the front door of his house to his car, and back!\n\nThere is no history of injury to the shoulder or adjacent region. You also find out that he is right handed.\n\nOn direct questioning, Mr. McCoy denies experiencing numbness or tingling in the ipsilateral arm or fingers.\n\nNor is there a history of fever, weight loss, rashes, respiratory symptoms, or pain involving any other region of the body.\n\nHis medical and surgical histories are only significant for a hiatal hernia discovered incidentally one year ago, for which he is on Omeprazole therapy.\n\nHis family history is also unremarkable.\n\nHe drinks around a litre of beer each Friday, but is \u0027stone cold sober\u0027 during the rest of the week.\n\nHis smoking has been limited to a very short period of experimentation during his youth.\n\nMr. McCoy laughs out loud when you ask him about recreational drug use.\n"}]}

2

{"ops":[{"insert":"Examination reveals his body mass index (BMI) to be 31.35 kg\/m2.\n\nAll vital signs are stable, and the general examination reveals no abnormalities.\n\nProceeding to the left shoulder, you note that the overlying skin appears normal, with no obvious swelling or deformity.\n\nThe joint is not tender, and both active and passive movements are normal. The drop arm test is negative and no focal neurological signs are present.\n\nThe contralateral shoulder joint is clinically normal, as are all other joints in the body.\n\nThe remainder of the examination is unremarkable.\n"}]}

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