A Not So Simple Case Of Shoulder Pain

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A Not So Simple Case Of Shoulder Pain - Page #1

Author: Ruikang Liu, MD Co Author #1: Jessica Butts, MD Senior Editor: Kristine Karlson, MD, FAMSSM Editor: Jason Blackham, MD Patient Presentation: 13 year old male right hand dominant baseball pitcher presented to sports medicine clinic for right shoulder pain. History: He had insidious onset of pain shortly after the start of the baseball season without identifiable trauma. Pain was localized to the anterior/superior right shoulder and was exacerbated during the acceleration and follow through phase of a throw. Intensity ranged from 7-8/10 during a throw and 5-6/10 during general play but no pain at rest or with activities of daily living. Heat, ice, stretching, and Advil all helped the pain. He has been playing baseball since age 7. ROS neg for swelling, ecchymosis, numbness/tingling, weakness, rashes or constitutional symptoms. Physical Exam: Vitals were normal. Right shoulder had mild downsloping compared to the L. No atrophy. No focal tenderness to palpation. Active and passive forward flexion and abduction of the shoulder limited bilaterally R>L, with R side abduction and forward flexion of 150 degrees. Shoulder internal rotation to L2 on R and L4 on L. R scapular dyskinesis noted during abduction with early activation, delayed release and mild protraction. Pain is reproducible with resisted shoulder abduction and provocative testing of infraspinatus and supraspinatus (localizes more to proximal humerus than RC). Strength 5/5. Negative belly press, empty can, Hawkin's/Neer's, Speed/Yergason, O'Brien's, shift/clunk, and sulcus sign. Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.		Back
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