Author: Terra Blatnik, MD
Co Author #1: Susannah Briskin MD
Co Author #2: Allison Gilmore MD
Co Author #3: Amanda Weiss-Kelly MD
16 year old previously healthy male football player presenting with four days of shoulder/chest pain.
Patient was playing hide and seek in the dark with some friends. While running, he tripped and hit his shoulder on a street curb. He had immediate pain in his right shoulder and trapezius. The patient was taken to a local emergency department where plain x-rays of the right shoulder were obtained. The x-rays were negative, and the patient was sent home in a sling and instructed to follow-up with his primary care doctor. Four days later, the patient continued to have persistent shoulder/chest pain and was complaining of mild difficulty breathing and swallowing while lying supine.
Patient was in no acute distress with normal vital signs. Range of motion testing of the right shoulder showed 15 degrees of forward flexion and abduction, which was limited by pain. Neck range of motion was normal. There was tenderness to palpation and swelling noted over the right sternoclavicular joint. Prominence of the sternoclavicular joint was noted while the patient was lying supine. No tenderness was noted elsewhere in the shoulder girdle or cervical spine. Neurologic and vascular exams were negative.
Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.