General Internal Medicine Q 24

A 54-year-old man is evaluated for a 6-month history of right shoulder pain. He describes the pain as moderately severe aching that is diffusely localized over the shoulder without radiation to the arm. The pain is constant, although it is worse at night and with any shoulder movement. The pain was insidious in onset and has been progressively worsening. He has had no neurologic or constitutional symptoms. Ibuprofen provides some pain relief.

On physical examination, vital signs are normal. Pain and limited range of motion are noted with both active and passive movement in all planes of motion, as is diffuse tenderness over the anterior and posterior areas of the right shoulder. There is no tenderness to palpation of the bony or soft tissue structures, nor is there cervical spine tende rness. There are no neck symptoms or findings.

Which of the following is the most likely diagnosis?

A Acromioclavicular joint degeneration

B Adhesive capsulitis

C Bicipital tendinitis

D Rotator cuff disease

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