Loss of motion
Mary is 75 years old and right-handed. She has had pain in her right shoulder for many years.
It has been minor and she has used over-the-counter anti-inflammatory medication from time to time. She remains active despite a few medical problems which are well controlled — hypertension and type 2 diabetes.
Over the past three months, the pain has worsened. She is now having trouble sleeping and has lost motion in her shoulder. She is having difficulty dressing and washing her hair.
Clinical examination of her right shoulder shows only 60 degrees of active forward elevation associated with weakness of external rotation. There is mild glenohumeral crepitus, which is painful, and her external rotation is to neutral only.
Her GP refers her for an X-ray, which shows glenohumeral osteoarthritis and a high-riding humeral head. Since