Patient (38-year-old female) Demographic reports improvement in right shoulder pain since last visit. Morning stiffness persisting but improved. Pain level reduced from 7/10 to 4/10. Physiotherapy exercises reported as helpful. No adverse effects from ibuprofen.

Right shoulder examination Examination performed — active flexion 140° (improved from 110° at previous visit). Clicking present on movement, non-painful. No crepitus. No signs of instability.

Right shoulder impingement — improving. Good response to conservative management (physiotherapy + NSAIDs). Range of motion improving. Pain reducing. ICD-10: M75.1 (Rotator cuff syndrome)

Reduce ibuprofen from BD to daily x 2 weeks, then cease if pain manageable. Continue physiotherapy (2 sessions remaining). Follow-up review Follow-up consultation in 4 weeks. No new referral required. Treatment plan modified Management change — medication dose reduced.

Consultation duration: ~15 minutes Time marker