PART 1: A 45 year old construction worker presents to your clinic with a chief complaint of deep achy pain in the left deltoid region, which occasionally extends into the left lateral elbow region. The patient indicates that the pain began insidiously "a few months ago" during which he would occasionally feel minor discomfort during the lifting of heavy objects at work. He indicates that he began to experience mild discomfort in the shoulder in the morning about a month ago, and this past week his pain awoke him from his sleep. He experiences the pain daily and throughout the day, describing it as a low grade ache with periodic sharp pain during some shoulder movements.

1. [a] What is your most probable primary diagnosis? [b] Justify how you arrived at this diagnosis from the details presented in the above case study?
2. [a] What physical assessment test would you perform to confirm your diagnosis (provide the proper name of test)? [b] Describe the specific details on how to perform this test and what signs/symptoms you would look for during this test to confirm your diagnosis?
3. [a] What conditions that we discussed in class would you be concerned with potentially developing if your primary diagnosis in 1a is allowed to become persistent or chronic? [b] What specific strategies/recommendations/treatments would you provide to your patient to prevent the condition in 1a from becoming persistent or chronic?

PART 1 OF THIS CASE STUDY IS UNDERSTOOD AND DONE, the diagnosis is a rotator cuff tear. I need help with part 2, please.

PART 2: Two years later, the same patient presents to your clinic with a chief complaint of mild tingling into the medial aspect of his left lower arm and hand. He indicates that the symptoms began insidiously about one month ago. The tingling does not present with any particular pattern during the day, and when it does is intermittent. He indicates that he feels it slightly more when slouched over his laptop for a long period of time. He has not tried anything to relieve it. There is no loss of function or weakness in his grip strength. He indicates that the tingling is sometimes worse at night, but manageable. His clinical history is unremarkable except for a minor motor vehicle accident 6 months ago and his family history is unremarkable.

4 [a] What is your most probable primary diagnosis? [b] Justify how you arrived at this diagnosis from the details presented in the above case study?

5 [a] What test(s) would you perform to confirm your diagnosis? [b] Describe the specific details on how to perform this test and what signs/symptoms you would look for during this test to confirm your diagnosis? [c] What muscle(s) are you specifically testing for using this test?

6. List two other potential differential diagnoses that you should consider and/or rule out to confirm your diagnosis. Justify anatomically why you feel these could be differential diagnoses.

7. If a patient comes into your office complaining of tinging into the hand, what would be your next logical question and why? Justify your answer.