A 47-year-old male construction worker presents to the orthopedic clinic with right shoulder pain and weakness for the past three months. He reports difficulty with reaching behind his back to tuck in his shirt and lifting heavy objects close to his body. History of Present Illness: The patient states that he initially felt a sharp pain in his right shoulder while lifting a heavy toolbox overhead. Over the following weeks, his shoulder pain persisted, and he developed progressive weakness in certain movements. He particularly struggles with internal rotation and has noticed a decrease in shoulder stability. The pain is dull and aching, worse with activity, and occasionally radiates down the upper arm. He denies numbness, tingling, or recent trauma. Past Medical History: No prior shoulder injuries No known arthritis or inflammatory conditions No history of diabetes or smoking Medications: Over-the-counter ibuprofen for pain relief Review of Systems: Musculoskeletal: Right shoulder pain and weakness Neurologic: No numbness, tingling, or weakness in the hand General: No recent weight loss or fever Physical Examination: Inspection: No visible deformity, mild swelling over the anterior shoulder Palpation: Tenderness over the lesser tuberosity of the humerus Range of Motion (ROM): Internal rotation: Weak and painful External rotation & abduction: Intact Special Tests: Positive lift-off test: Inability to lift the dorsum of the hand off the lower back Positive belly-press test: Weakness when pressing the hand against the abdomen Normal empty can test and Neer’s impingement test Diagnostic Workup: MRI of the right shoulder: Partial-thickness tear of the subscapularis tendon Which of the following is the best initial management approach for this patient?
