4th & Clavicle - Page #1

Author: Thomas Stocklin-Enright, DO
Co Author #1: Dr. Kenzie Johnston
Senior Editor: Mandeep Ghuman, MD, FAMSSM

Patient Presentation:
14 year-old junior varsity running back presented following an injury sustained to his right shoulder 4 days prior. He described a mechanism of injury where he was tackled with a lineman landing on his posterior right shoulder. He was seen at an outside hospital the following day and discharged with a simple sling for treatment of a right acromioclavicular (AC) Sprain versus Salter-Harris (SH) Type 1 injury to his proximal humeral physis. Due to persistent pain over the weekend his athletic trainer referred him for further evaluation. At our initial evaluation he complained of dyspnea and dysphagia in the setting of persistent AC and Sternoclavicular (SC) pain. The non-radiating, sharp pain (5/10) was localized to the AC/SC joints. His pain was provoked by overhead motion and deep breathing. It was relieved using the simple sling and shallow breathing. He denied any numbness, paresthesia, or weakness in his right upper extremity.


Physical Exam:
VS: BP 138/86, HR 62, RR 14
General: NAD
Neuro: CN II-XII intact bilaterally. Gross sensation intact in bilateral upper extremity (BUE)
Vascular: Capillary Refill >2 seconds, Radial pulses palpable in BUE
Left upper extremity: grossly normal without deficit in ROM, sensation or motor function.
Right Upper Extremity: No lacerations, obvious visual depression of clavicle. Tender over AC Joint, SC Joint, and notable superior elevation of SC Joint and anterior clavicular process palpated posterior compared to the contralateral side. Shoulder AROM flexion/abduction to 90 degrees, Full Active/Passive ROM of wrist and elbow. Normal AIN/PIN/Ulnar Nerve motor function. Median/Ulnar/Radial Nerve distributions intact

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