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INSTRUCTIONS FOR THE DOCTOR

This is a short case.

Please do a focused clinical examination. You are not required to take any further history. Tell the examiner your examination findings, your differential diagnosis and initial plans for management.

Scenario

Martin Chatterjee is a 48-year-old office manager who does little regular exercise. Last week he played Masters’ cricket and scored a career best of 32 runs. He does not recall specifically injuring his shoulder, but has since had pain in his left (non-dominant) shoulder. He is finding it difficult to move his left arm and to sleep, as the pain wakes him up whenever he tries to move. He has applied ice and is taking paracetamol at night. This is his first experience with a shoulder problem.

The following information is in Martin’s medical record:

  • Medical history

  • Type 2 diabetes diagnosed two years ago

  • Height 1.85 m

  • Weight 106 kg

  • BMI 31 kg/m2

  • Waist circumference 95 cm

  • Medication

  • Metformin 500 mg bd

  • Paracetamol 500 mg 2 nocte prn

  • Allergies

  • Nil

  • Social history

  • Office manager

  • Stopped smoking two years ago.

INSTRUCTIONS FOR THE PATIENT, MARTIN CHATTERJEE

You are a 48-year-old office manager who does little regular exercise. Last week you played Masters’ cricket and scored a career best of 32 runs. Since then you have had pain in your left (non-dominant) shoulder. It is difficult to move your left arm and to sleep as the pain wakes you up whenever you try to move. You have applied ice and are taking paracetamol at night. This is your first experience with a shoulder problem.

The following information is on your medical record:

  • Medical history

  • Type 2 diabetes diagnosed two years ago

  • Height 1.85 m

  • Weight 106 kg

  • BMI 31 kg/m2

  • Waist circumference 95 cm

  • Medication

  • Metformin 500 mg bd

  • Paracetamol 500 mg 2 nocte prn

  • Allergies

  • Nil

  • Social history

  • Office manager

  • Stopped smoking two years ago.

Please wear a shirt that buttons all the way down the front. You have no difficulty unbuttoning the shirt but struggle to take your shirt off (removing your arms from the sleeves) because of the pain in your left shoulder.

You have no bony tenderness. You have difficulty abducting your left shoulder. When the doctor gets your shoulder beyond the 120° angle you can then raise your arm and the pain eases.

All other shoulder movements are normal.

INSTRUCTIONS FOR THE FACILITATOR

Please report to the doctor that neck/back movements and axillae are normal when they start to examine these. This is to save time.

SUGGESTED APPROACH TO THE CASE

Introduction

Brief summary of the case by the candidate leading to request to examine the patient.

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