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A Curious Case Of Right Arm Pain - Page #1
 

Author: Lukas Buttke, MD
Co Author #1: Dr. Shayne Fehr, MD
Co Author #2: Dr. Kevin Boyd, DO
Senior Editor: Christian Fulmer, DO, FAMSSM
Editor: Irvin Sulapas, MD

Patient Presentation:
Right shoulder pain

History:
Patient was a 16-year-old male who initially presented for right shoulder and wrist pain. He was a competitive volleyball player and noticed an achy, anterior shoulder pain at the top of his swing that would radiate to his hand and wrist. He felt his wrist pain was in the area the ball would make contact. He has tried PT in the past for 2-3 weeks without any improvement. He had no swelling. He had intermittent paresthesias in his dorsal wrist and hypothenar eminence. He denied any skin color changes. There was no prior history of any right upper extremity injuries.

Physical Exam:
Inspection: There were no rash or skin lesions, no atrophy, no swelling,
Palpation: Fairly diffuse tenderness over the anterior and lateral shoulder w/o focality. Mild volar TTP where the ball contacts the wrist.
ROM: Full pain-free PROM and AROM of the right shoulder and wrist
Strength: 5-/5 shoulder IR and ER, 5-/5 abduction, 4+/5 supraspinatus, 5-/5 wrist flexion and extension
Neurovascular: No sensory deficit to light touch in the bilateral upper extremities, upper extremities warm and well perfused
Special tests: Neer and Hawkins-Kennedy negative, cross adduction negative, speeds negative, apprehension negative, Jobe's positive, Sulcus sign positive, Anterior slide test positive w/ laxity, Negative loading of TFCC, dorsal pain with resisted wrist extension

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, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.
 

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