A 55-year-old right-handed house painter has had a constant dull ache in his right shoulder for 3 weeks. The pain worsens when he steers his car or elevates his arm, and the inability to raise his arm above his head interferes with his work. The pain radiates to his neck and upper right arm (but not the forearm); at night, it occasionally becomes severe enough to waken him. Neck movement does not make the pain worse, and he has no weakness or numbness in his right arm or hand.
There is no history of acute trauma. He has had intermittent shoulder pain for the past few years that was alleviated by acetaminophen.
The patient has type 2 diabetes and hyperlipidemia. His medications include atorvastatin, metformin, and low-dose aspirin.
What is your presumptive diagnosis at this point?
A. Statin-induced myositis.
B. C5-C6 nerve root compression.
C. Rotator cuff impingement syndrome.
D. Acromioclavicular joint arthritis.
E. Diabetic neuropathy.
1. Richmond JC, Shahady EJ. Sports Medicine for Primary Care. Cambridge, Mass: Blackwell Science; 1996.