Acute Traumatic Shoulder Pain From Recreational Football Injury - Page #1

Author: Michael Villasin, MD, MPH
Senior Editor: Rahul Kapur, MD
Editor: Moira Davenport, MD

Patient Presentation:
19 year old right hand dominant male presents with left shoulder injury sustained while playing recreational football the night prior to presentation..

Patient was not wearing any protective equipment when he fell on an outstretched left hand. As he landed his left arm hyperextended while in a mildly abducted position. He immediately felt a pop and tearing sensation. He had 8-10 minutes of numbness and paresthesia in his left arm, which has since resolved. He has persistent pain over his left pectoralis and proximal bicep. He denies prior injury to the left shoulder/upper extremity. He denies any previous pain at night. He has tried ice and ibuprofen with minimal improvement.

Physical Exam:
Left upper extremity exam showed ecchymosis along the medial aspect of the upper arm with tenderness to palpation along the lateral pectoralis and proximal biceps. He had medialization of the bulk of the pectoralis major muscle with a drop nipple sign. There was clear asymmetry of the axillary fold with the left arm In abduction and external rotation. Case Photo #1 . Pectoralis major muscle spasm was noted with the arm in flexion and adduction.

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