Table of Contents
Common Questions
Chat with CodyMD
Cody's Chat with Patient
Cody's AI Summary
Top 3 AI Diagnosis List
Review by Dr Albert DiPiero
Resource Center
Testimonials
Share this Case Study
Case Study
Meet your host
Albert DiPiero, MD MPH FACP
I am a co-founder and the Chief Medical Officer at CodyMD and your host for this edition of Cody Grand Rounds. I have been a practicing physician and faculty member at medical schools for over 26 years.
About The AI Doctor Case Study
CodyMD is a partnership between Human Doctors and AI Doctors. Cody is an AI Doctor who helps thousands of people every day. At each Cody Grand Rounds, I select a real case and review it with Cody, the AI Doctor.
Each case is based on a real patient but has been modified to maintain privacy and to emphasize certain teaching points.
Common Questions
What are common causes of right shoulder pain?
How can I tell if I have a rotator cuff injury?
What is impingement syndrome, and how is it treated?
What are the symptoms of a frozen shoulder?
Can playing tennis cause shoulder pain?
What is the difference between shoulder pain and shoulder stiffness?
Can over-the-counter medications help shoulder pain?
Chat with CodyMD
Click the button below to initiate a conversation with CodyMD, your AI Doctor.
Cody's Chat with Patient
Below is a conversation transcript between the patient and our AI Doctor CodyMd.
Cody, the AI Doctor
Hello! I understand you're experiencing some right shoulder pain. Is that correct?
Patient
Yes, that's right.
Cody, the AI Doctor
Good to meet you! My goal is to provide you with an accurate assessment and plan. Let's talk about your shoulder pain. When did the pain start?
Patient
It started about two weeks ago.
Cody, the AI Doctor
Thank you for sharing that. How would you describe the pain? Is it sharp, dull, aching, or something else?
Patient
It's more of a dull ache, but it becomes sharp when I move my arm in certain ways.
Cody, the AI Doctor
Understood. On a scale of 1 to 10, with 1 being no pain and 10 being the worst pain imaginable, how would you rate your shoulder pain?
Patient
I would say it's around a 6, but it goes up to an 8 when I move it a certain way.
Cody, the AI Doctor
I see. Have you experienced any recent trauma or injury to your shoulder, like a fall or heavy lifting?
Patient
No, I can't think of any specific injury.
Cody, the AI Doctor
Any previous history of shoulder problems or surgeries?
Patient
No, this is the first time I've had any issues with my shoulder.
Cody, the AI Doctor
Have you noticed any swelling, redness, or warmth around the shoulder?
Patient
No, there's no swelling or redness, and it doesn't feel warm.
Cody, the AI Doctor
Do you have any difficulty with shoulder movements, such as lifting your arm, reaching behind your back, or other activities?
Patient
Yes, it's really painful to lift my arm above my head or reach behind my back.
Cody, the AI Doctor
Have you been using any over-the-counter medications or treatments for your shoulder pain?
Patient
I've been taking ibuprofen, but it only helps a little.
Cody, the AI Doctor
Thank you for that information. Do you experience pain during the night, especially when lying on the affected shoulder?
Patient
Yes, sleeping has been difficult. I wake up whenever I roll onto my right shoulder.
Cody, the AI Doctor
Have you noticed any numbness, tingling, or weakness in your arm or hand?
Patient
No numbness or tingling, but my shoulder does feel weaker than usual.
Cody, the AI Doctor
Alright. Do you engage in any repetitive activities, either at work or during sports, that involve your shoulder?
Patient
I play tennis a few times a week.
Cody, the AI Doctor
Thanks for sharing that. Do you have any other medical conditions or take any other medications?
Patient
No, I'm generally healthy otherwise and don't take any regular medications.
Cody, the AI Doctor
Aside from pain, have you noticed any stiffness in your shoulder?
Patient
Yes, it's become quite stiff.
Cody, the AI Doctor
Understood. Are there any specific movements or activities that seem to worsen your shoulder pain?
Patient
Reaching above my head and behind my back makes it worse, and serving in tennis has become really painful.
Cody, the AI Doctor
Thank you for your detailed responses. You've been very helpful.
Cody's AI Summary
- You are a 41-year-old man with right shoulder pain that started about two weeks ago.
- The pain is described as a dull ache that becomes sharp with certain movements.
- You rate the pain as 6 out of 10, increasing to 8 with specific motions.
- There has been no recent trauma or injury, and you have no history of shoulder problems or surgeries.
- There's no swelling, redness, or warmth around the shoulder, but you do have difficulty with movement, especially lifting your arm and reaching behind your back.
- The pain disrupts your sleep and feels worse when lying on the affected shoulder.
- You haven't noticed any numbness or tingling, but the shoulder feels weaker.
- You play tennis a few times a week, which may involve repetitive shoulder movements. No other medical conditions or regular medications.
Top 3 AI Diagnosis List
Based on the information and conversations with Cody, we have prepared a top 3 AI Diagnosis List.
1. Impingement Syndrome(50 % probability)
This condition occurs when the tendons or bursa in the shoulder are compressed during shoulder movements. It often causes pain when lifting the arm or moving it above the head.
2. Rotator Cuff Muscle Injury(30 % probability)
This can include strains or tears in one of the muscles or tendons that make up the rotator cuff. Symptoms commonly include pain and weakness in the shoulder, particularly during lifting or rotating the arm.
3. Frozen Shoulder(20 % probability)
Also known as adhesive capsulitis, this condition involves stiffness and pain in the shoulder joint, often worsening over time and severely limiting movement.
Review by Dr Albert DiPiero
Dr. Albert DiPiero
In reviewing the patient’s history and symptoms, I agree with Cody’s prioritization of likely problems. The history of a 41-year-old experiencing right shoulder pain for two weeks presents several important considerations. The absence of recent trauma, coupled with the types of activities that exacerbate the pain, points to some common shoulder pathologies.
1. Impingement Syndrome( 60% probability)
This syndrome is highly likely given your involvement in tennis, which entails repetitive shoulder movements. The pain when lifting your arm and the absence of trauma align with this diagnosis.
2. Rotator Cuff Muscle Injury(30% probability)
The rotator cuff is often implicated in shoulder pain, especially with activities like tennis. Although you reported no specific injury, repetitive stress can lead to microtears and inflammation, resulting in pain and weakness.
3. Frozen Shoulder(10% probability)
While possible, frozen shoulder typically develops gradually and includes significant stiffness which severely limits movement. The acute nature and sudden onset of your symptoms make this a less likely diagnosis.
Next Steps for Evaluation
Physical Examination: Confirming range of motion limitations and specific pain points of the shoulder during various shoulder maneuvers is critical in the diagnosis.
Imaging: An MRI or ultrasound would be useful to get a detailed view of the shoulder structures, particularly to evaluate the rotator cuff and rule out higher-grade injuries or tears.
Potential Treatment Modalities
Physical therapy focusing on rotator cuff strengthening and flexibility is a common intervention.
Combined with continued use of NSAIDs like ibuprofen or naproxen can provide relief.
For impingement, activity modification and possibly steroid injections might be necessary.
Treatment should start conservatively with physical therapy and NSAIDs, escalating as needed based on follow-up assessments.
Resource Center
Testimonials
Dr Cody spot on, better than most Human Drs. Also far more pleasant. Try him, he could better help you understand your issues. He will give you good info for your Drs visit as well.
TrustPilot Review
It gave me the best response possible and suggested simple self care treatment options which I'm in favor with. It has a to the point interface and brief answer for better understanding.
Attentive and asked questions. I really felt like all my symptoms were taken into account and evaluated without being dismissed
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