unusual cause of shoulder pain
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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 - PowerPoint PPT PresentationTRANSCRIPT
Unusual Cause of Shoulder Pain
Unusual Cause of Shoulder Pain
James N. Robinson, M.D.American Sports Medicine
Institute
James N. Robinson, M.D.American Sports Medicine
Institute
HPIHPI
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
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 continuedHPI 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
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 HistoryPast History
PMHx: Asthma on Dulexa PSHx: None Social: Junior, HS football center
PMHx: Asthma on Dulexa PSHx: None Social: Junior, HS football center
Physical ExaminationPhysical 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
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
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 continuedPE 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
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
QuestionsQuestions
Differential DiagnosisDifferential Diagnosis
Scapular fracture Shoulder Contusion Rib contusion/fracture Rotator Cuff Impingement Small Pneumothorax Asthma Exacerbation Pulmonary Embolism Pulmonary Contusion
Scapular fracture Shoulder Contusion Rib contusion/fracture Rotator Cuff Impingement Small Pneumothorax Asthma Exacerbation Pulmonary Embolism Pulmonary Contusion
A&PA&P
Final Diagnosis: Right 1st Fracture
Management Placed in Shoulder Immobilizer in
slightly adduction No contact Return in 2 weeks
Final Diagnosis: Right 1st Fracture
Management Placed in Shoulder Immobilizer in
slightly adduction No contact Return in 2 weeks
2 week Follow Up2 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
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 up4 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
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 OutcomeFinal 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
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