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A case of non-traumatic shoulder pain

A woman in her 40s presented with a three month history of progressive non-traumatic right shoulder pain. Shedescribed the pain as a dull and continuous ache and rated its severity as 9 out of 10. Her symptoms were exacerbated when raising her right arm and lying on her right side. The pain interfered with many of her daily activities, in particular cleaning as her profession. She had no relevant medical or surgical history and was not taking regular prescribed drugs. She used over-the-counter analgesics as required, but they did not alleviate the pain. Clinical examination revealed substantially reduced movement of the right shoulder to 90° flexion and 90° abduction. Although there was no limitation in passive internal and external rotation,moderate pain was elicited with these movements. As examination raised the possibility of intrinsic failure of the rotator cuff tendon, the shoulder was radiographed (fig 1).