A 45 year old female presents to your OPD with complaints of pain in her left shoulder and numbness of left arm . She says the pain radiates to anterior and left side of her chest.

 A 45 year old female presents to your OPD with complaints of pain in her left shoulder and numbness of left arm . She says the pain radiates to anterior and left side of her chest.

She also gets short of breath and swelling of her legs on walking.

On clinical examination, her BP is 140/80 mHg and Oxygen saturation is 96 % on air. Her respiratory rate is 14 / minutes.

There is no pedal oedema , JVP is not raised .

She appears Obese .

Auscultation of the lungs reveal no crepitations or added sounds and bilateral equal air entry in both lung fields.

You decide to organize some investigations.

1 .Which Investigations would you organize in her case ?

2 . What could be the most likely Diagnosis in this case ?

3 . What are the management options for this patient ?

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Answers given in comments section.

1 .Which Investigations would you organize in her case ?

Chest X ray : To visualize lung fields and heart size which will give us an idea of Congestive Cardiac Failure.

ECG : To exclude Ischaemic heart disease as the patient although complains of Pain in shoulder , but she does say it radiates to left side of her chest and also there is high Blood pressure and symptoms suggestive of CCF which can co- exist with IHD.

X ray of left shoulder to exclude presence of arthritis.

Her Blood Pressure is High hence it might be a good idea to organize Random Sugar Levels , Cholesterol levels or Lipid Profile , Uric acid and Renal function Tests Including EGFR , Urea and Creatinine and serum albumin levels apart from Full Blood Count and serum Haemoglobin.

2 . What could be the most likely Diagnosis in this case ?

While the Chest X ray and ECG show no obvious pathology ,most likely Diagnosis : left frozen shoulder / Adhesive capsulitits as can be seen by X ray findings where the head of humerus seems to be trapped in the shoulder joint.

Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by stiffness and pain in your shoulder joint.

Signs and symptoms typically begin gradually, worsen over time and then resolve, usually within one to three years.

3 . What are the management options for this patient ?

Therapy

A physical therapist can teach patient range-of-motion exercises to help recover as much mobility in the shoulder as possible.

Surgical and other procedures :

Most frozen shoulders get better on their own within 12 to 18 months. For persistent symptoms, folllowing are useful :

Steroid injections. Injecting corticosteroids into shoulder joint may help decrease pain and improve shoulder mobility, especially in the early stages of the process.

Joint distension. Injecting sterile water into the joint capsule can help stretch the tissue and make it easier to move the joint.

Shoulder manipulation. Ithe doctor moves your shoulder joint in different directions, to help loosen the tightened tissue.

Surgery. Surgery for frozen shoulder is rare, but if nothing else has helped, surgery to remove scar tissue and adhesions from inside your shoulder joint may be done. Doctors usually perform this surgery with lighted, tubular instruments inserted through small incisions around shoulder joint (arthroscopically).

        
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