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A 45-Year-Old Man Comes to the Physician for Pain and Stiffness

Question 1010
Multiple Choice
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Multiple Choice

A 45-year-old man comes to the physician for pain and stiffness in his left shoulder for the past 3 months.  His symptoms were mild in the beginning and intermittently affected his daytime activities.  The pain and stiffness have worsened in the past month and are constant throughout the day and night.  The pain is worse with lying on the shoulder.  The patient, a professional painter, recalls no injury and has no other symptoms.  He has a history of type 1 diabetes mellitus, depression, and psoriasis.  Examination of the left shoulder shows no focal tenderness but global restriction in all directions with both active and passive range of motion.  The right shoulder joint has normal range of motion.  The remainder of the physical examination is within normal limits.  X-ray of the left shoulder is normal without significant osteoarthritis of the glenohumeral joint. An appropriate diagnosis is made after the patient is evaluated.  Which of the following is the best next step in management of this patient?

A)Oral glucocorticoids
B)Range of motion exercises
C)Referral for orthopedic surgery
D)Therapeutic ultrasound
E)Tumor necrosis factor-alpha inhibitor

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