A 65-year-old man presents to his family physician with a 3-week history of right lateral shoulder pain that began after he fell onto the shoulder while walking on ice. The pain is worse at night when he lies on that side and when he reaches overhead. He has hypertension treated with amlodipine, no history of peptic ulcer disease, and no known drug allergies. On examination, there is pain during active abduction between about 60 and 120 degrees, and the Neer and Hawkins tests are positive. Passive range of motion is full, and resisted abduction and external rotation are painful with mild weakness. The external rotation lag sign and drop-arm test are negative, and the neurovascular examination is normal. Shoulder radiographs show no fracture or dislocation. Creatinine is normal, with eGFR 85 mL/min/1.73 m2 (greater than 60).
| Heart rate | 72/min |
| Respiratory rate | 14/min |
| Temperature | 36.8 °C |
| O2 saturation | 98%, room air |
| Blood pressure | 128/78 mm Hg |
Question 1 of 30
Which of the following are the most appropriate initial management options?
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