Author: Courtney Kandler
Co Author #1: Courtney Kandler
Co Author #2: Gale Prentiss, MD
Co Author #3: Justin Young, MD

Patient Presentation:
A 19-year-old male college football defensive lineman complains of very severe posterior shoulder pain after working out.

History:
The patient was preparing for spring camp by doing strenuous weight training. His pain is localized over the left posterior shoulder with peri-scapular radiation, and is maximally experienced with overhead lifting. He took naproxen and this did not help his pain. Ice and electrical stimulation also provided little relief. It has worsened over the past two weeks. He denies any direct trauma to the region, nor any weakness, numbness, or tingling. The patient does report a history of left sided stingers years ago, but states this feels completely different.

Physical Exam:
Shoulder: Full range of motion in flexion, extension, abduction, and adduction, but with full forward flexion and abduction there is pain over the posterior shoulder. There is no tenderness to palpation over the clavicle, acromioclavicular joint, glenohumeral joint, or sternoclavicular joint. There is tenderness to palpation over the posterior shoulder, specifically the superior-medial border of the scapula and the distal trapezius. Strength is 5/5 in abduction, external rotation, and internal rotation. Hawkin’s and Neer’s tests are negative. Speed’s test is negative. Roos test is negative. The radial pulses are 2+ bilaterally.
Neck: Full range of motion in flexion, extension, and side bending. Spurling’s test is negative. Deep tendinous reflex of triceps, biceps, and brachioradialis are 2+ and symmetric. Sensation to light touch is intact. Palpation over thoracic and cervical spine elicits no pain.
Back: Smooth scapulothoracic motion

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