The janitor began to have shoulder pain about 5 months ago, even when he wasn't moving. Also, his fingernails are clubbed.
Tendinitis has been the diagnosis for this middle-aged janitor during previous visits to the ED. By now his intermittent right shoulder pain has persisted for about 5 months. It can be exacerbated by motion, but sometimes it is painful even when he is immobile, and sometimes it wakes him at night.
Now you notice that he also has clubbing of the fingernails.
What is your diagnosis?
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