D: What brings you here today?

P: Um so I'm here because my shoulder has been really painful for the past week um and any movement of that shoulder, of my right shoulder, causes a lot of pain.

D: OK, and how long have you been having uh this pain for?

P: For the past week,

D: Past week, OK. Um and did you injure your shoulder at all recently? Any trauma to the area or anything like that?

P: Um so about like, a couple of months ago, I um was do, I I work in construction so um I was moving around some heavy objects and um I guess like the repetitive motions caused some sort of rotator cuff injury. But I had that um, like I got that treated and everything was fine for a couple of months. But this pain just started a week ago.

D: OK, and where is this pain located exactly?

P: Um it's it's just like in my shoulder, like at the joint between my upper arm and um shoulder.

D: OK, and uh is it an aching pain or is it a sharp stabbing pain?

P: So at rest it seems to be like achy and stiff, but um but when I move my shoulder, when I try to move it, it it causes more of a sharp pain.

D: Sharp pain, OK and what kind of movements cause the sharp pain? Or is it just any movement?

P: Uh any movement.

D:  OK. Are there any uh movements that are worse in particular?

P: Um I think um, like no, anything hurts.

D: OK. OK, and how much would you rate this pain out, on a scale of zero to 10, 10 being the worst pain you felt in your life?

P: I'd give it about a 7. 

D: Seven, OK.

P: Yeah.

D: And are you having uh, is this pain moving to any other uh joints or any other part of your body?

P: No. 

D: OK, so just just in the area that you described?

P: Yes. 

D: OK, and do you notice any kind of um, just looking at your shoulder outside, from the outside, any swelling, redness, any masses or deformities?

P: No, I don't see anything like that.

D: OK, alright and um is there anything that you've tried that has helped with your pain?

P: Um I've tried some ibuprofen, some ice. It seems to help temporarily.

D: OK, and earlier when you had the rotator cuff injury, did you get physiotherapy? 

P: Um I did. But not, but I didn't finish the full course. I just went for a week or so and then um I had to go back to work, um so I stopped doing that.

D: I see, um yeah, so that's something definitely uh it's very important and we'll need to consider going forward as well. Other than that, are you having any symptoms of any fevers or chills?

P: Uh no, nothing like that.

D: OK, and have you been sick recently at all or met with someone who was sick?

P: No.

D: OK, any any weight loss um or loss of appetite? Anything like that?

P: Uh no, nothing like that.

D: OK, any numbness or tingling? 

P: No.

D: Any weakness in your extremities?

P: No.

D: Any um any just symptoms or anything else like diarrhea, constipation, urinary changes? Anything else is going on?
 
P: No. 

D: No, OK. So it's mainly just the shoulder pain?

P: Yes. 

D: OK, um alright, and does rest help at all, like when you're lying down, just not moving your shoulder. Does that help with your pain?

P: Uh, yeah I would say so.

D: OK. And is is this stiffness there just throughout the day, or is it there in the morning and then gets better during the day?

P: It's pretty much there all day.

D: OK. Alright um and have you been diagnosed with any medical conditions in the past?

P: Uh, I have um, I have diabetes, but that's about it.

D: OK, and do you take any medications?

P: I'm on metformin. 

D: OK. Um and do you have any allergies to any medications?

P: No, no allergies to medications.

D: Have you been hospitalized or had any surgeries in the past? 

P: No. 

D: No, OK. Um any family history of any musculoskeletal or rheumatological conditions?

P: No. 

D: OK, and currently right now, so you said you work as a construction worker, right?

P: Yes.

D: And are you off of work right now, or have you been off work um due to your previous injury and pain, or are you still working?

P: I'm still working, but modified, um so I am not uh lifting any heavy objects or anything like that. I'm just doing some like groundwork.

D: OK, that's good. Yeah, I mean, um we might also need to, if you're doing any kind of overhead like work where you're raising your arms above your shoulders, that might uh, cause further problems as well, so we'll look into some of those modified duties as well.

P: OK.

D: Um yeah, and what is your living situation like right now? Who do you live with?

P: Um I live by myself right now.

D: Do you live in a house or apartment?

P: Um I live in an apartment. 

D: And, uh, uh, in terms of your daily life, do you smoke at all?

P: Um I don't smoke. I used to smoke before, but that was like 20 years ago.

D: OK, that's good, and do you use any recreational drugs like marijuana or any other drugs?

P: Uh no, no.

D: How about smoking, you smoke cigarettes? Sorry, you said you you quit. Um do you drink alcohol?

P: I'll drink like a glass of wine here and there.

D: OK. Alright, um yeah, and those were some of the questions I had for you. In terms of just a physical examination, uh when you press on the area that you describe, um when you press around the area, does it hurt?

P: I have to press pretty hard for it to hurt.

D: OK, but otherwise it's not tender?

P: No.

D: OK, and again, no swelling, redness, or anything like that, just it's mainly just on the inside?

P: Yeah.

D: OK, and um and any kind of movement hurts, right? There's no particular movement that, like if you were instead of um trying to raise that shoulder by itself, if you were to just move it with the other arm. Does it hurt?

P: The other arm? The other arm doesn't hurt at all.

D: Or like if you were to use your left arm to to passively move your right arm and shoulder. Does that hurt or is it when you just try to move the right arm by itself?

P: It's, oh, it still hurts, any any moving of the shoulder hurts.

D:  OK, alright, so yeah, so based on what um you've told me so far in your recent shoulder cuff injury, what can sometimes happen is uh with those injuries, you might get some um inflammation and what might happen is something called uh adhesive capsulitis, or just commonly knows as known as a frozen shoulder. And there's different stages, so that might happen, so in the initial stages like freezing um and then there's stiffening in stage two, and then usually after 6 to 12 months it starts uh getting better.

P: OK.

D: Um and it might also affect your other shoulder as well. So what we'll um end up doing today is see if um we can get some um imaging done so we can do an X-Ray of your shoulder. I'm sure you've had X Rays before, so we'll kind of compare them to your shoulder X Rays from before. We, if we need to, we can also get an ultrasound if um we don't, uh we can't really tell from the X Rays. And then from there, um we can get some blood work as well. Um just your normal blood work as well as inflammation markers, and then um from there we'll need to uh, really um discuss some management strategies. So you've already tried some physiotherapy, but now we need to make sure that's uh, it's it's consistent because this is something that has a high recurrence rate and we will definitely need to finish the full course of physiotherapy, whatever it may be, um because if physiotherapy doesn't work, we may have to consider like other options like um corticosteroid injections right into your shoulder.

P: OK. 

D: For some relief.  But yeah, so first we'll just try some conservative methods like physiotherapy, pain management, uh and then go from there. How does that sound?

P: That sounds pretty good. Thank you.

D: Welcome, alright, so we'll call you for the X-Rays and then we'll go from there.

P: OK, sounds good.