Shouldering the burden: a case of pain in the middle-aged female athlete
Bibliographic record
Abstract
A 56-year-old previously well left-handed woman presents to her family physician with a 2-year history of pain and stiffness in her left shoulder. She describes a constant ‘ache’ that became ‘sharp’ when playing tennis or golf. Over the last 2 months, the pain has become increasingly worse and she has had to reduce her tennis matches from four times per week to only once. On examination, there was a soft tissue swelling over the left shoulder with no bruising or muscle wasting. Her pain reproduced with active abduction of the left shoulder while the passive range of motion was full. There was reduced power with abduction and flexion of the shoulder. Sensation was intact in the upper extremity. Plain films and an ultrasound examination were performed (figures 1 and 2). Figure 1 Anteroposterior radiograph of the patient's left shoulder demonstrating a focus of calcification within a tendon of the rotator cuff, superior to the humeral head (arrow). Calcium deposition can be localised to the rotator cuff by anteroposterior radiographs in internal and external rotation as well as the axillary lateral radiograph. Figure 2 Sonographic image of the shoulder demonstrating a supraspinatus calcium deposit appearing as a well-circumscribed, anechoic focus with posterior acoustic shadowing (arrow). What is the most likely diagnosis? For answer see page 1135 Shoulder pain is a frequent complaint among patients and diagnosing the cause can be challenging, often requiring imaging studies. As the first-line modality, plain radiography should be ordered for all patients with pain persisting beyond 6 weeks.1 The differential diagnosis for this middle-aged female patient with atraumatic shoulder pain includes arthritis and rotator cuff pathology. However, before considering these more common causes, it is important to exclude infection and malignancy. Septic arthritis is …
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.004 | 0.003 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.008 | 0.003 |
| Insufficient payload (model declined to judge) | 0.004 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".