1 / 13

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

ilori
Download Presentation

Unusual Cause of Shoulder Pain

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Unusual Cause of Shoulder Pain James N. Robinson, M.D. American Sports Medicine Institute

  2. 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

  3. 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

  4. Past History • PMHx: Asthma on Dulexa • PSHx: None • Social: Junior, HS football center

  5. 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 Physical Examination

  6. 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

  7. Questions

  8. Differential Diagnosis • Scapular fracture • Shoulder Contusion • Rib contusion/fracture • Rotator Cuff Impingement • Small Pneumothorax • Asthma Exacerbation • Pulmonary Embolism • Pulmonary Contusion

  9. A&P • Final Diagnosis: Right 1st Fracture • Management • Placed in Shoulder Immobilizer in slightly adduction • No contact • Return in 2 weeks

  10. 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

  11. 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

  12. 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

More Related