Rotator cuff tendinopathy — SCE Rheumatology MCQ

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ModerateOsteoarthritis and Soft Tissue RheumatologyRotator cuff tendinopathySCE Rheumatology

A 67-year-old man has lateral shoulder pain worse overhead, a painful arc from 60 to 120 degrees and pain on resisted abduction with preserved passive range. What is the most appropriate investigation?

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Correct answer: E — Ultrasound if tear or persistent symptoms are suspected

Ultrasound if tear or persistent symptoms are suspected is the single best answer because painful arc with preserved passive movement suggests rotator cuff tendinopathy. The stem is testing investigation selection, not isolated recall, so the relevant clinical pattern and risk context determine the answer. Synovial fluid microscopy, Gram stain and culture is less suitable because it fits a different clinical pattern or a different treatment threshold; MRI of the sacroiliac joints, High-resolution CT chest and Renal biopsy do not address the key discriminator in this vignette. Clinical pearl: in SCE-style rheumatology questions, autoantibodies, imaging and synovial fluid findings should be interpreted with the whole phenotype.

Reference: NICE NG226; NICE CKS soft tissue rheumatology