<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 27-year-old man comes to the physician because of intermittent right shoulder pain for the past 2 weeks. The pain awakens him at night and is worse when he lies on the right shoulder. He does not have any paresthesia or numbness in the right arm. He is a painter, and these episodes of pain have not allowed him to work efficiently. He appears healthy. Vital signs are within normal limits. Examination shows painful abduction of the arm above the shoulder. There is severe pain when the elbow is flexed and the right shoulder is internally rotated. Elevation of the internally rotated and outstretched arm causes pain over the anterior lateral aspect of the shoulder. An x-ray of the shoulder shows no abnormalities. Injection of 5 mL of 1 lidocaine into the right subacromial space relieves the pain and increases the range of motion of the right arm. Which of the following is the most appropriate next step in management?? A: MRI of the shoulder, B: Intraarticular glucocorticoids, C: Arthroscopic repair, D: Physical therapy, E: Thoracic outlet decompression,  <response>: This is a clinical vignette describing a 27-year-old man with right shoulder pain that is worse at night and with certain movements, suggesting a diagnosis of impingement syndrome. The history and physical exam findings of pain with abduction, internal rotation, and flexion are classic for impingement. The x-ray is normal. The lidocaine injection provided temporary relief, confirming the diagnosis. The choices include advanced imaging with MRI, intraarticular steroids, arthroscopic surgery, physical therapy, and thoracic outlet decompression surgery. MRI would not be the next step since the diagnosis is already clear based on history, exam and response to lidocaine. Surgery would be premature without first trying conservative management. Thoracic outlet decompression does not fit with the clinical presentation. The most appropriate next step would be a trial of conservative physical therapy to treat the impingement syndrome. If this fails, intraarticular steroids could be considered before surgery.D: Physical therapy 