Paul is a 53-year-old, right-handed plumber who presents with a two-week history of right shoulder pain. Pain severity is 7/10, worse at night and unrelieved by simple pain relief strategies.

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Paul is a 53-year-old, right-handed plumber who presents with a two-week history of right shoulder pain. Pain severity is 7/10, worse at night and unrelieved by simple pain relief strategies. There is associated shoulder weakness but no sensory disturbance or neck pain. There is no history of neck or shoulder injury. Work does not involve a lot of overhead activity, but over the Christmas period, Paul worked nearly double his usual hours. He is otherwise well with no history or systemic symptoms of note. On examination, you note the finding shown in the video below. There are no other motor abnormalities of the upper limb or neck, associated focal tenderness or sensory deficit. Upper limb reflexes are normal.

The answer is c. Long thoracic neuropathy