A shoulder to cry on

Author: Kyle Wilson / Editor: Steve Corry-Bass / Reviewer: Ashwin Prasad Shanmugam / Codes: SLO4, TC2, TP7 / Published: 31/03/2023

A 34-year-old patient presents to the Emergency Department (ED) of a busy district general hospital in which you are working. She complains of shooting pain across the right side of the neck, shoulder, and upper arm.

The rest of the history is unremarkable. The patient has no allergies and she has not had any relief from paracetamol or ibuprofen.

You discover through questioning that the patient’s pain affects the right side of her neck, her shoulder and her arm. It started suddenly when she fell onto an abducted and externally-rotated arm whilst carrying her daughter. She has a near-constant, sharp, shooting pain which radiates down her right arm. She is mildly nauseous, but otherwise feels systemically well. The pain is made significantly worse by movement but there are no obvious alleviating factors.