A 45-year-old man presents to the emergency department with left shoulder pain after a motorcycle accident. The patient denies any neck, back, chest, or abdominal pain or other complaints. He notes that he was wearing a helmet and full leather gear when he was sideswiped and lost control.

Vital Signs and Physical Examination

The patient’s vital signs are normal. Physical examination is notable for tenderness and decreased range of motion to the left shoulder associated with guarding but is otherwise unremarkable. The patient has no abdominal, chest, or spinal tenderness.

Figure 1. Radiographic image of left shoulder after motorcycle accident. Credit: Brady Pregerson, MD.

Can you diagnose this condition? What additional test should you perform to confirm the diagnosis?

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