A 64-year-old is experiencing chronic pain and weakness in his dominant arm and

Question

A 64-year-old is experiencing chronic pain and weakness in his dominant arm and shoulder for the previous 2 months, with no previous trauma. He has minor pain on palpation of the right shoulder. His pain is increased with arm abduction of more than 90° and has weakness with external rotation of the arm. He cannot maintain his arm in an elevated position for more than a few seconds. An injection of local anesthetic relieves his pain but does not help with the weakness.

Questions:

a) Explain the possible anatomical causes for each of these symptoms and identify the anatomical structures likely to be involved.

b) Identify three differential diagnoses (diseases or conditions that present similar signs and symptoms that could possibly account for the student’s symptoms) with appropriate justifications. Provide the most likely diagnosis based on this analysis.

c) Explain the various treatment options for the presenting symptoms.

Explanation / Answer

Shoulder pain is common symptom in primary care.it can be intrinsic shoulder problem and it can also be referred from other structures.shoulder and arm pain have many cause .

1.The shoulder is made up of numerous,glenoid,scapula,acromion,clavicle .The three significant articulations the sternoclavicular joint ,the acromioclavicular joint and the glenohumeral joint ligaments and surrounding musculature including the rotator cuff muscled contribute to shoulder joint stability .Rotator cuff is group of muscled and their tendons that surround shoulder joint and connect shoulder blade to upper arm bone .Bursae a small sac near the joint provide lubricating fluids that decreases friction among bones tendons and ligaments. A cuff of cartilage called labrum forms a cup for ball like head of humerous to fit into it.

2.The diagonisis of shoulder and arm pain can be one of the following problems

1.Rotator cuff tear:-it includes shoulder pain and weakness and loss of muscled.

2.Swimmers shoulder:-Shoulder pain and arm pain

3Rotator cuff tendinitis:-Shoulder pain ,tenderness

4.Frozen shoulder;-Shoulder pain and joint stiffness

4.bursitis:-Shoulder pain and joint pain.

5.osteoarthritis:-due to common wear and tear with ageing .

6 Stinger:-neurological injury in which their is pain in shoulder and arm

7.Heart Atrack: Arm or shoulder pain can be common symptom of impeding heart attack called Angina.

TREATMENT

Resting is good thing in such conditions.Changing the activities. Avoiding unusual routine .and taking anti inflammatory drugs .And shoulder surgery is also a solution for these problems.Arthosscopic surgery ,physical therapy and taking pain relievers like Tylenol,mortin,Steve.Taking corticosoid injections is also helpful.before going for these treatments make sure to go for MIR scan,CT scan and X rays.

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