Sonoscope Clinic Report

Specialty: Advanced Clinical Practitioner History: This gentleman presents with a 3-month history of worsening right shoulder pain, specifically located in the deltoid region, exacerbated by overhead movements and lifting. He reports no previous musculoskeletal injections. His main medical conditions include well-controlled hypertension managed with Ramipril 5mg daily. He denies any allergies. Previous investigation reports include an X-ray from 2 months ago, which showed mild degenerative changes in the glenohumeral joint but no acute fracture or dislocation. The pain is eased by rest and paracetamol. This gentleman's year of birth is 1968. Clinical Findings: On examination of the right shoulder, active range of motion was limited in abduction to 90 degrees and flexion to 120 degrees due to pain. Passive range of motion was similarly restricted. Palpation revealed tenderness over the anterior aspect of the greater tuberosity. Neer's and Hawkins-Kennedy tests elicited significant pain, suggestive of subacromial impingement. No obvious swelling or erythema was noted. Ultrasound Scan: The ultrasound scan of the right shoulder revealed evidence of subacromial bursitis with a small amount of fluid and mild thickening of the bursa. There was also tendinosis of the supraspinatus tendon without evidence of a full-thickness tear. Potential treatment options discussed included injection therapy, further physiotherapy, and watchful waiting. The conclusion of the scan was consistent with subacromial impingement syndrome and supraspinatus tendinosis. Conclusion: * 3-month history of right shoulder pain exacerbated by movement. * Clinical findings consistent with subacromial impingement. * Ultrasound scan demonstrated subacromial bursitis and supraspinatus tendinosis. Intervention: The findings were discussed with this gentleman. We also discussed therapeutic options, including injection therapy. Following this discussion, Mr. Smith agreed with the suggested procedure. Informed consent was obtained in accordance with the completed and signed online informed consent form and he read the steroid injection information leaflet explaining risks and side effects. The ultrasound probe was cleaned with Tristel Duo OPH probe cleaning solution. The skin was prepared and cleaned with Clinell Chlorhexidine 2% / Alcohol 70% skin preparation solution. Ultrasound-guided injection of Depo-Medrone 40mg (expiry 11/2025, batch 12345) mixed with Lidocaine 1% 2ml (expiry 05/2026, batch 67890) was performed. The procedure was uneventful and the steroid was accurately placed in the subacromial bursa of the right shoulder. Recommendation: Relative rest for 3-5 days, gradual return to activity, and avoidance of high-intensity physical stress on the right shoulder for the next 2 weeks. I now recommend further orthopaedic review.