 On examination, she has 4 plus over 5 strength in the left biceps and triceps muscle groups, 4 out of 5 left deltoid, 5 out of 5 otherwise in both muscle groups and all muscle groups of upper extremities.  Light touch sensation is minimally decreased in the left C6 distribution; otherwise, intact.  Biceps and brachioradialis reflexes are 1 plus.  Hoffmann sign normal bilaterally.  Motor strength is 5 out of 5 in all muscle groups in lower extremities.  Hawkins and Neer impingement signs are positive at the left shoulder.