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A 42-year-old male presents with complaints of right shoulder pain, following an incident when he lifted an outboard motor out of the water while at work. At the time of the incident, he felt a pop and a sharp pain in his right shoulder. The patient saw his primary care physician to diagnose his condition as a shoulder strain and prescribed a trial of physical therapy. Since that time the patient reports not quite being able to use the shoulder the same as previously, and that his right arm feels stiff and weak when attempting to elevate it overhead. The pain is localized to the right shoulder and he has no other complaints. His past medical and surgical history is unremarkable.

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Based on this limited history, what is most likely wrong with his patient shoulder?

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Given the history of trauma, the symptoms reported by the patient at the time of the accident, and the subsequent loss of function in the shoulder, a provisional diagnosis of a rotator cuff tear could be made. The extent of the tear may be elicited with a thorough physical examination.

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  • There is no evidence of ecchymosis at the shoulder.
  • Mild tenderness is elicited with palpation over the right proximal humeral tuberosities and bicipital groove.
  • When asked to elevate the right time actively, the patient does so by placing his hand on the outside of his ipsilateral thigh and then moving his hip outwardly while bending his trunk over to the opposite side. The patient is only able to elevate the arm momentarily to about 40° without this substitution.
  • Internal and external rotation of the right shoulder, both passively and actively, was within normal ranges, although painful through these ranges.
  • The following special tests were negative: Yergason's, Speed’s and Adson’s.
  • The patient demonstrated a positive drop arm test.
  • All neurologic tests were negative.

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Have the results of the tests and measures confirmed a diagnosis? If so, which one?

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It is highly likely that this patient suffered a full thickness tear of the right rotator cuff.

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What is the classification of injury in rotator cuff tendon disorders?

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What is your differential diagnosis?

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What area of the rotator cuff tendon is most susceptible to involvement in these type of injuries?

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What is the classification of injury in rotator cuff tendon disorders?

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What is your differential diagnosis?

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What imaging techniques are best suited for confirmation of the rotator cuff tear?

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