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Hard Lumps For A Softball Player - Page #1
 

Author: Akas Siddiqui, MD, MPH
Co Author #1: Scott Darling, MD
Co Author #2: John Leddy, MD, FACP
Editor: James Robinson, MD

Patient Presentation:
A 35-year-old right-handed Caucasian male accountant and recreational softball player presented to the sports medicine clinic with a complaint of right shoulder pain.

History:
He reported a large, lateral shoulder outgrowth that was firm and had been present for several years. It became painful at times. His symptoms had been worsening over the past several months, mostly with shoulder movement past 90 degrees. He complained of spasm in his right rhomboid muscle but denied numbness or paresthesia. His pain level at its worst was 7/10. Tylenol #3 helped minimally. He described a history of Hereditary Multiple Exostoses/Osteochondromas that had resulted in several surgical procedures of the wrists and forearms. He also had large right lateral pelvis and left knee exostoses, but he had deferred surgical removal of these as they were felt to be more cosmetic.

Physical Exam:
Constitutional: Appears stated age, under-developed and well nourished, with hypoplastic upper extremities bilaterally.

Musculoskeletal:
-Head/Neck: No tenderness.
-Shoulders:
Inspection/Palpation: No atrophy of the right shoulder. Tenderness of the right greater tuberosity with protuberant exostosis laterally at the proximal humerus that is slightly tender to palpation. No tenderness of the right acromioclavicular joint.
Strength: External rotation 5/5 bilaterally. Internal rotation 5/5 bilaterally. Supraspinatus 5/5 bilaterally. Normal muscle tone bilaterally.
ROM: Right forward flexion 120 degrees, right abduction 100 degrees, full right internal and external rotation bilaterally. Full range of motion of the left shoulder.
Special Tests: Empty can test, Hawkins-Kennedy impingement test, and subscapularis lift-off tests negative on the right.

Skin: No rashes, lesions, or ecchymosis. There are several previous surgical scars present on the forearms.

Neurological: No deficits.

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.


NOTE: For more information, please contact the AMSSM, 11639 Earnshaw, Overland Park, KS 66210, (913) 327-1415.
 

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