A 62-Year-Old Woman With Right Shoulder Pain

Introduction. A 62-year-old right-handed woman presents with chronic right shoulder pain that she has been feeling for more than 1 year.

Patient history. The patient noted that her consistent, aching pain becomes more severe in certain positions, movements, and uses. Specifically, she feels a sharp pain at night when lying on her right side. She also feels an increased pain intensity when reaching overhead for high objects, when placing her right arm behind her back in the shower, putting on a coat, or toward the end of a pickleball session.

The patient feels symptomatic pain relief with varying combinations of nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen. Although she is unable to trace the shoulder issue to any prior acute traumatic event, she remains an active athlete. Indeed, the patient is quite healthy with no major medical diagnoses or chronic medications. When she was younger, she played competitive field hockey and volleyball.

A focused office orthopedic examination revealed some tenderness to probe palpation of the upper biceps and coracoid process areas with pain exacerbation during overhead motions (abduction). There was relative strength weakness when resistance was placed again with overhead and abduction movements of the right shoulder. When the right arm is passively elevated to 180° and the patient is asked to lower it actively, she reports no pain initially but increasing pain as it drops toward the halfway point of the downward arc then decreasing pain to the resting ends point ("painful arc test.")