Disclosures: Brittany D. Dukes, MD:

Case Diagnosis: 62-year-old female with 1 year of evolving right shoulder pain

Case Description: Relevant history included right carpal tunnel syndrome and remote proximal humerus fracture complicated by non-union managed with ORIF 13 years ago with subsequent revision 2 years later. She reported lateral shoulder pain 10 months ago after lifting office supplies overhead, worse with movement and side-laying. An outside physician initially provided a glenohumeral corticosteroid injection without improvement. She was then seen by orthopedic surgery 2 months later, who provided a subacromial bursa injection, physical therapy referral, and ordered a diagnostic ultrasound. Ultrasound revealed full-thickness right rotator cuff tear involving the posterior supraspinatus and infraspinatus tendons and normal biceps tendon. Patient returned several weeks later with medial elbow pain and paresthesias consistent with medial epicondylitis with ulnar neuritis. She was subsequently provided new PT prescription, NSAIDs, and brace. Patient returned 2 months later, with predominantly anterior shoulder pain concerning for biceps tendonitis and was referred to PM&R for US injection of right bicep tendon sheath. Ultrasound revealed the screw was in direct contact with the long head of biceps tendon (LHB).

Setting: Outpatient musculoskeletal clinicAssessment/

Results: Patient was tender to palpation via ultrasound probe over area of the bicipital groove. Ultrasound revealed the anterior projecting humeral screw was in direct contact with LHB. Procedure was converted from corticosteroid injection to complete diagnostic ultrasound evaluation. Review of remote humerus radiographs demonstrated a screw projecting anterior to the humeral cortex. Findings were discussed with the referring surgeon and patient subsequently underwent right arthroscopic rotator cuff repair, biceps tenotomy, and subacromial decompression, currently progressing well postoperatively.

Discussion: This case highlights the dynamic nature of musculoskeletal care and the importance of personally reviewing diagnostic imaging.

Conclusion: A thorough evaluation should be performed before proceeding with corticosteroid injections. In the event of new or unexpected findings, clinicians should adjust plan accordingly.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/chronic-evolving-shoulder-pain-a-case-report/