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Tricky case... need help!

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Patient is a 50 year old man with a long term history of DM, as well as a history of hydrocephalus for the past year. He's had recent worsening b/l hand weakness and shoulder pain as well as decreased ROM, despite injections and PT. He also gets intermittent swelling in his hands, but denies any numbness.

On examination, he has only about 90 degrees of abduction in his shoulders, although abduction strength is normal for that range. Strength is normal proximally, but he has 3/5 grip and...

Tricky case... need help!

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