A 57-year-old man with type II diabetes mellitus presented with right shoulder pain and weakness. The onset of symptoms was insidious and progressive over a two year period. The patient thought he initially injured his shoulder while swimming but noted that his symptoms had become much worse since re-injuring it while throwing a tennis ball 6 months before presentation. The pain was localized to his right shoulder and often awakened him from sleep. He had taken nonsteroidal anti-inflammatory drugs (NSAIDS) for the 6 months after re-injuring the shoulder and completed an intermittent course of physical therapy that included a rotator cuff strengthening program. He was an active person who enjoyed hunting and fishing but had been unable to do either because of the shoulder problems.

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