A 65-Year-Old Man Comes to the Office Due to Right

A 65-year-old man comes to the office due to right upper extremity pain after falling on his right outstretched hand 2 days ago.  The patient has mild abrasions over his wrist and elbow with full range of motion and no tenderness over these joints.  He has severe pain when he tries to lift his arm above shoulder level or when he pulls or pushes with his right arm.  He has been unable to sleep the last 2 nights due to pain and is unable to lie on the affected side.  The patient has a 40-pack-year smoking history.  His father died of multiple myeloma.  Vital signs are normal.  Examination shows limited active abduction and external rotation of the humerus; however, passive motion is comparable to the contralateral side.  Palpation of the right shoulder, collarbone, and neck reveal no step-off deformities or point tenderness.  Radial pulse, extremity sensation, muscle tone, and bulk are normal.  Which of the following would most likely confirm the diagnosis in this patient?

A) Bone scan
B) Chest x-ray
C) CT scan of the shoulder
D) MRI of the cervical spine
E) MRI of the shoulder
F) Shoulder x-ray

Correct Answer:

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