Author Affiliation: Dr Burkhart is Clinical Associate Professor, Baylor College of Medicine and the University of Texas Health Science Center, San Antonio.
Clinical Crossroads Section Editor: Margaret
A. Winker, MD, Deputy Editor.
DR PARKER: Mrs B is a 26-year-old teacher whose
activities are severely limited by chronic left shoulder pain. She has been
treated with nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy,
and cortisone injections without adequate improvement. Mrs B lives in a suburb
of Boston and has managed care insurance.
During adolescence, Mrs B experienced back pain and was diagnosed as
having kyphosis and lordosis, for which she wore a brace. Despite this, she
remained active in sports. Four years ago, pain began in both shoulders without
any preceding trauma or other joint symptoms. Her internist, and subsequently
several orthopedists, evaluated her. The initial diagnoses included subdeltoid
bursitis, rotator cuff tendonitis, and impingement.
Burkhart SS. A 26-Year-Old Woman With Shoulder Pain. JAMA. 2000;284(12):1559-1567. doi:10.1001/jama.284.12.1559