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Clinical Case Study

Shoulder pain

Background

A 36-year-old male presented to the clinic with a 5 day history of sudden onset right shoulder pain. 

 

He denied any injury or recent change in activity. He was normally fit and well. His only PMH was recent COVID-19 infection 2 weeks ago.  

His symptoms were constant in nature, but seemed to be worse at night causing significant disturbance. 

He reported no cervical red flags (5Ds and 3Ns), and no association with food or abdominal pain.

He worked in a supermarket as a warehouse assistant. He was a Non-smoker, and acquired minimal amounts of alcohol. His hobbies involved football and computer gaming. 

Clinical presentation

Clinical examination revealed significant pain and discomfort to the right shoulder, with pain also felt in the upper-traps region and down in the forearm. 

Objectively there was visible muscle wastage to the deltoid muscle group and upper traps. There was no sign of any discoloration or superficial veins.

 

Shoulder ROM was severely limited by pain and "heaviness" of the arm. Neck ROM was restricted with contralateral side flexion and rotation. 

Differential Diagnoses

Some possible differential diagnoses for this case include

  • Calcific tendonitis

  • Cervical radiculopathy

  • Parsonage-Turner Syndrome

  • Can you think of any others? 

Working diagnosis

The working diagnosis for this case was Parsonage-Turner syndrome (PTS). PTS is a rare neurological disorder that is characterized by sudden and severe shoulder pain, weakness, and numbness in the affected arm. The symptoms are caused by inflammation of the brachial plexus. A recent viral illness is one of the most common factors associated with the development of the disorder.

What next?

The patient was referred on to secondary care for further investigation. Needle EMG and MRI confirmed PTS linked to viral illness. 

The patient was referred to the GP for a pain medication review in the interim. 

Once the acute phase has settled, PTS is usually managed with physiotherapy.

References

Feinberg JH, Radecki J. Parsonage-Turner syndrome. HSS J. 2010;6:199-205. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2926354/

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