Progress Letter

Dear Dr. Mitchell,

Thank you for reviewing Marcus Vance (DOB: 14/05/1982, Medicare: 2948 58201 2), a 42-year-old male carpenter whom I have been treating for a 6-week history of atraumatic R shoulder pain, aggravated by overhead reaching and heavy lifting at work.

At the first assessment, the patient demonstrated R shoulder active ROM: flexion 110°, abduction 95° with a painful arc (70°–110°), external rotation 45°, and internal rotation to L3. MMT: supraspinatus 3+/5 (pain-limited), infraspinatus 4/5, subscapularis 5/5. Positive Neer and Hawkins-Kennedy tests. NPRS 7/10 with overhead activity. In addition, an US dated 02/10/2024 showed a 5 mm partial-thickness bursal-sided tear of the R supraspinatus tendon with associated subacromial bursitis.

The treatment modalities used so far include glenohumeral joint mobilisations, soft tissue therapy to the posterior cuff, scapular stabiliser retraining, and a progressive isometric-to-isotonic rotator cuff strengthening HEP, alongside taking meloxicam (Mobic®) 15 mg PO OD. The patient has demonstrated moderate improvement, with R shoulder active flexion increasing to 145°, abduction to 130°, supraspinatus MMT improving to 4/5, and NPRS reducing to 4/10, though pain persists with sustained overhead loading.

I plan to progress his dynamic rotator cuff strengthening and workplace-specific functional conditioning over the next 4 weeks, and I believe an US-guided subacromial corticosteroid injection may be warranted if his painful arc plateaus. I would greatly value your input and opinion regarding Marcus. I will continue monitoring the patient's progress and modify the treatment plan when required.

"Please feel free to contact me if I can provide any further assistance."

"Yours sincerely," Sarah Jenkins, APAM.