Unusual Cause of Shoulder Pain
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Transcript Unusual Cause of Shoulder Pain
Unusual Cause of Shoulder
Pain
James N. Robinson, M.D.
American Sports Medicine
Institute
HPI
16 y/o Junior, Center Football player presents
on Monday with Right shoulder and chest
pain following Friday night football game
He doesn’t remember any one specific hit,
but started having achy shoulder pain
sometime in 3rd quarter
Pain continued to get worse and eventually
kept patient out of game
The pain got so bad that he went to the ER
that night and was told that he possibly had a
rib fracture
HPI continued
Patient describes his pain as deep to his
scapula
Pain with Abduction of shoulder and with
deep inspiration, but does not feel SOB
No pain with adduction and his pain is better
with arm held across body
No pain previously
Pain was worst day after game and has
continued through weekend
No numbness or weakness
Past History
PMHx: Asthma on Dulexa
PSHx: None
Social: Junior, HS football center
Physical Examination
6 ft, 215lb
Pt in obvious discomfort
No bruising noted
Tenderness to palpation
of the scapula especially
along medial border
No tenderness over AC,
SC, clavicle, or
glenohumeral joint line
Shoulder ROM: Flexion
150, abduction limited
95 due to pain, no pain
with ER/IR
Weakness of
supraspinatus with
extreme discomfort
Weakness with ER, no
weakness with IR
No increase
anterior/posterior
translation
PE continued
Respiratory: CTAB though pain with
deep inspiration
Rib palpation on the right side does not
reproduce pain, no cervical tenderness,
or no tenderness over sternum
FROM of neck without pain
+2 distal pulses, good capillary refill
Questions
Differential Diagnosis
Scapular fracture
Shoulder Contusion
Rib contusion/fracture
Rotator Cuff Impingement
Small Pneumothorax
Asthma Exacerbation
Pulmonary Embolism
Pulmonary Contusion
A&P
Final Diagnosis: Right 1st Fracture
Management
Placed in Shoulder Immobilizer in slightly
adduction
No contact
Return in 2 weeks
2 week Follow Up
Pain much improved and minimal in
immobilizer
FROM of shoulder, slightly decreased
strength, mild tenderness to palpation of
scapula
Sent to PT to work on ROM and strength of
shoulder and cervical
Continue non-contact, but can condition
Return in 2 weeks
4 week Follow up
Doing well, no pain
Asthma physician obtained bone density scan
due to chronic steroid use which was normal
PE full motion and strength, no tenderness
XR showed slight callus
Patient allowed to start light contact and
progress if no pain
Final Outcome
Patient return to full play at 5 weeks
out from injury
He completed the rest of his football
season (3 more weeks)
He has no residual pain or problems