A 65-Year-Old Woman Comes to the Physician Because of Worsening

question 384

Multiple Choice

A 65-year-old woman comes to the physician because of worsening right shoulder stiffness for the last 3 months.  She denies any trauma or previous shoulder problems.  She also reports a history of chronic low back pain and knee pain.  She works as a librarian and has been lifting more books recently since her library expanded its book collection.  Her other medical problems include diabetes, hypertension, and hypercholesterolemia.  
Her temperature is 36.5 C (97.7 F) , blood pressure is 130/80 mm Hg, pulse is 85/min, and respirations are 14/min.  Her lungs are clear and her heart sounds are normal.  Muscle strength is 5/5 in the lower extremities with intact sensation and 5/5 in the biceps bilaterally.  She has markedly decreased passive and active range of motion in right shoulder.  Her reflexes are 2+ throughout and she has a normal gait.  The remainder of her physical examination is within normal limits.
Which of the following is most appropriate next step in management?

• A)Complete rest and tramadol
• B)Oral steroids
• C)Range of motion exercises
• D)Steroid joint injection
• E)Strengthening exercises

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