CASE
A 37-year-old Hispanic woman was referred to our clinic for insidious severe pain in her left shoulder. During history-taking, she noted that she awoke one morning with the pain. She did not recall experiencing any trauma or doing any heavy work during the preceding day. Her primary care physician had given her hydrocodone/acetaminophen for pain and recommended applying ice packs to the shoulder. He also gave her IM ketorolac. She had minimal pain relief with no change in her shoulder motion and was referred to us 5 days after the pain began.
On physical examination, she was in moderate distress, as evidenced by protective posture of the left shoulder and facial expressions. She exhibited no signs of neck pain or respiratory distress, and she denied any chest pain. Her left shoulder was tender to palpation over the greater tubercle of the humerus and supraspinous fossa. There was no erythema, edema, induration, or ecchymosis of the shoulder or left upper extremity. Range of motion in the shoulder was limited by pain to approximately 20° forward flexion and abduction. Internal and external rotation were nearly impossible secondary to pain. The remainder of the physical examination was unremarkable. Her medical history included type 2 diabetes mellitus and hypertension. Figure 1 shows a radiograph of the left shoulder.
What does this image reveal?