There is no tenderness over the cervical spinous processes or paraspinal musculature. Shoulders appear level, without evidence of regional swelling or erythema. The left scapula is more prominent than the right, with a mild degree of muscular wasting just above and below the scapular spine. She is tender over the left greater tubercle, where the rotator cuff tendons insert onto the humerus, but not elsewhere over the shoulder girdle. Left serratus anterior, tested by resisting shoulder protraction, increases scapular winging.
Sensation is intact.
Hawkins impingement test, shoulder forward flexion to 90 degrees and subsequent shoulder internal rotation, is positive, recreating anterolateral shoulder symptoms. Neer's impingement test, shoulder forward flexion with internal rotation, does not reproduce shoulder pain. Spurling maneuver, cervical extension, lateral bending and axial compression, does not reproduce symptoms radiating into the ipsilateral upper extremities. At this point, review your differential diagnosis and revise as appropriate. Commentary IV History and initial exam findings are consistent with rotator cuff tendinitis and bursitis.