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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

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Unusual Cause of Shoulder Pain

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  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

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