Author: Joseph O'Brien, DO
Senior Editor: Carolyn Landsberg, MD
Editor: Daniel Murphy, MD
A 16 year old right hand dominant male with no significant past medical history presents to the outpatient clinic with a 2.5 month history of right shoulder pain.
Right shoulder pain began after grazing a tree while skiing. He initially had pain in both arms and shoulders, but the left side pain resolved. The pain is located over the anterior and lateral aspects of the humeral head. It is constant and made worse with shoulder flexion and abduction. Chiropractic treatment of the neck and TENS unit have provided no relief. The patient notes that he has begun writing with his left hand secondary to pain and often awakens at night due to pain. He denies numbness or tingling. He runs track in the spring and participates in swimming during the winter.
Constitutional: Well-developed and well-nourished. No distress.
Skin: No erythema, ecchymosis, or warmth overlying the R shoulder
Neck: supple with full active range of motion in all directions and non-tender. Spurling test negative bilaterally.
R shoulder: Tender over humeral head into mid biceps. No clavicular step off. Right scapular winging. Active ROM limited to 10 degrees of flexion and 30 degrees of abduction, unable to internally or externally rotate without using his other arm to assist. Passive ROM to 90 degrees of flexion and abduction before pain prohibits further motion. Pain with Hawkins and O'Brien testing. Unable to hold arm in abduction against gravity.
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