Mike is a 45 year old man who has worked as a labourer at one of the steel plants in Hamilton for years. The work requires frequent heavy lifting, particularly overhead. Mike smokes 1 pack of cigarettes per day. He has had a 1 year history of shoulder pain, which seems to be getting gradually worse. He has had to give up baseball and now is having trouble performing his job. He has not tried any treatment for his shoulder, other than Tylenol plain and icing it. On physical exam there is no muscle wasting. He is tender over the anterolateral aspect of the humeral head. Range of motion is good, but terminal flexion and abduction reproduce his typical pain. Muscle strength testing shows weakness in abduction, which also reproduces his typical pain. Provocative tests for impingement syndrome are positive, but provocative A-C joint and biceps tendon tests are negative. X-rays are done to evaluate the bony anatomy, and an ultrasound is performed to evaluate the rotator cuff.