A 55-year-old male presents with gradual onset of right shoulder pain that's worse at night and interrupts his sleep. He describes the pain as deep and aching. He's unable to lie on the affected shoulder and has noticed progressive weakness when lifting objects. On examination, he demonstrates pain and weakness with active abduction of the arm, especially between 60 and 120 degrees. What could be the diagnosis and plan?
The patient's symptoms of deep, aching shoulder pain, nocturnal pain, weakness with lifting, and painful arc during abduction suggest a rotator cuff tear. The next step would be to obtain imaging, such as an ultrasound or MRI, to confirm the diagnosis. Treatment depends on the severity of the tear and the patient's functional needs. Conservative management includes physical therapy, pain control with NSAIDs, and possibly corticosteroid injections. Surgery may be considered in cases of severe or full-thickness tears, or if conservative management fails.