I wish someone can help me the below case:
I had a patient complaining of a gradual onest of left shoulder pain about 2-4 months due to a recent increase activities in daily life, or being active in her daily left after all the radiotherapy.

PMH: Breast lumpectomy on left, lymph node removal on left, hysterpectomy. Radiotherapy for 6 week.
History of occassional neck stiffness and pain, usually settled with chiropactor treatment.
Medication: Arcuxlex? (not sure the spelling)
Arggrvates by lifting things with left hand, sleeping on both left and right side, takng off clothes and swimming esp. in bring arms from back to front in breast stroke.
Ease: Avoid those movement.
She has a kyphotic upper back posture, her head and bilateral shoulders has displaced forward.
Upper trap is very tight, and her scapulae are wining on both left and right side.
I have check her neck movements, movement are slightly stiff, LSF increase pain on left, RSF and R ROt givining her a pulling sensation on left.
on pallpation, C3-T2 are stiff and tender.
AROM on left shoulder are painful in Flexion 90, abduction 90 , ER (90) 60. Other AROm are not restricted. PROM of flexion, abduction and ER (90) are painfree and full range.
Open and empty can test are painful and weak, Gd 4+; Speed test is painful and Gd 4+, Left off test is painfree and weak Gd 4. Palpation on biceps tendon is slightly tender. No tenderness is felt on other Wikipedia reference-linkrotator cuffs.
She has a reverse GH rhythm in flexion and abduction movement.
Compression and distraction of GHJ are painfree. Patient felt a slight pull in inferior glide and AP of GH at abduction 90.

May i know anyone has any idea of what sort of problem that she has? Any suggest on the treatment approach?
Many thanks.

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