A 25-year-old with shoulder pain after house painting has intact passive ROM with no trauma noted. What should the next step be to reach a diagnosis?

In this scenario, the focus is on assessing a patient with shoulder pain following a specific activity, particularly painting, rather than a traumatic event. Intact passive range of motion suggests that there may not be significant structural damage or serious injury to the shoulder joint, as the joint can still move freely when manipulated.

Palpating structures around the shoulder is a crucial next step because it helps to identify areas of tenderness, swelling, or abnormality in the surrounding musculature, tendons, ligaments, and the joint itself. This physical examination can provide valuable information regarding potential conditions, such as tendonitis, bursitis, or impingement syndrome that may have resulted from overuse, which is common in cases like this.

Identifying specific points of tenderness or discomfort can guide further evaluation and management, determining if conservative treatment is appropriate or if additional imaging is warranted. In contrast, immediately obtaining an MRI or X-ray without first conducting a detailed physical examination would not provide the same focused insight into the nature of the shoulder pain. An EMG is more suited for evaluating nerve or muscle issues and is not necessary in this context given the patient's symptoms and the lack of trauma.