Consultant Referral from Physio

Dr. Sarah Johnson Dear Dr. Sarah Johnson, I would value your opinion on John Smith, who is a 45-year-old construction worker experiencing severe right shoulder pain. John has a medical history that includes a previous rotator cuff injury and chronic lower back pain. His current lifestyle and activity levels involve heavy lifting and repetitive overhead movements at work. Recently, he has increased his workload, which may contribute to his symptoms. John first experienced shoulder pain that began two weeks ago. Since then, the symptoms have worsened. He reports that symptoms are aggravated by lifting and prolonged overhead activities and eased by rest and applying ice. The patient describes the pain as sharp and constant. There is no referred pain, no associated neurological symptoms, and no additional systemic concerns. On assessment, John reports symptoms during lifting and overhead activities, while cycling is pain-free. On palpation, there was tenderness over the anterior shoulder. Range of motion assessment showed restricted movement with discomfort at the end range. Functionally, there is reduced ability to lift heavy objects. Special tests, including the Neer and Hawkins-Kennedy tests, were positive. Lumbar spine mobility was full and pain-free. Given this presentation, I would value your opinion on John’s case to assist in further management. At this stage, I am considering the need for further investigation and specialist input before proceeding with rehabilitation. He has been advised to modify activity levels and reduce impact-loading as needed. If you require any further information regarding this case, please feel free to contact me. Yours sincerely, Dr. Thomas Kelly General Practitioner Greenfield Medical Practice