Some of the diagnoses that must be considered with this patient is referred pain from further metastasis to soft tissues and bone, adhesive capsulitis, rotator cuff injury, cervical radiculopathy.

Physical Exam Findings:

Weight: 150, Height: 5’6”

Cervical spine examination revealed mild sprains of her right lower cervical spine with little to no muscle spasms of the upper trapezius, levator scapula, scalenes or SCMs. Neurological evaluation of the cervical spinal nerves into the upper right extremity was normal.

Shoulder evaluation indicated severe restrictions in movement of her right shoulder. Flexion or abduction in the coronal plane was limited to 50 degrees, abduction in the scapular plane was limited to 80 degrees, abduction in the sagittal plane was limited to 60 degrees. Internal shoulder rotation was normal. External shoulder rotation was limited to 20 degrees. Extension was limited to 20 degrees. Pain was evident on all end ranges of motion.

Muscle weakness and trigger points were exhibited in the subscapularis, supraspinatus, biceps and teres minor. Yergason’s Test for bicipital tendinosis was negative. Drop arm test was not able to be performed due to the inability of the patient to abduct her shoulder.

Question: What is your working diagnosis at this point?