Approach to shoulder pain Quiz: Ace Your Exams

A 66-year-old man presents to his primary care physician for evaluation of left shoulder pain. The patient developed pain over the past two days and does not recall any preceding injury or trauma. He has pain with movement of the shoulder and when he is not moving it. The patient has also been experiencing chills and generalized fatigue over the same time period. The patient has a past medical history of hypertension, hyperlipidemia, gout, and Crohn disease. Medications include amlodipine, simvastatin, allopurinol, and infliximab. Temperature is 37.7°C (99.9°F), pulse is 101/min, respirations are 17/min and blood pressure is 148/92 mmHg. The patient appears fatigued. Physical examination demonstrates swelling, significant tenderness to palpation, and warmth over the left shoulder. The patient has significant pain and limited range of motion with both passive and active range of motion at the left shoulder. Which of the following is the most appropriate next step in management?