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Clinical Crossroads
September 27, 2000

A 26-Year-Old Woman With Shoulder Pain

Author Affiliations

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.

JAMA. 2000;284(12):1559-1567. doi:10.1001/jama.284.12.1559

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.