An Unusual Etiology To Chronic Shoulder Pain - Page #1
 

Author: David Ross, MD
Co Author #1: Rahul Kapur, MD
Editor: Meghan (Mimi) Raleigh, MD, MS
Senior Editor: Meghan F. Raleigh, MD

Patient Presentation:
The patient is a 34 year old male who presented with a complaint of chronic left shoulder pain.

History:
His mechanism of injury is unclear, but he believes that he injured his shoulder while playing football a few years ago. He noted that his left shoulder had always felt asymmetric compared to the right. His pain was associated with limited range of motion, especially in abduction and forward flexion. He had discomfort with certain exercises, especially with military press while weightlifting.

His pain acutely worsened two weeks ago while lifting his seven year-old daughter above his head. He notes that his pain is 8/10, sharp in character, was in the sternoclavicular (SC) joint and medial clavicle, but has now migrated laterally across the clavicle to the acromioclavicular (AC) joint. He denies any systemic symptoms or night time pain.

Physical Exam:
Inspection: no gross abnormalities including asymmetry, swelling, ecchymosis or muscular atrophy.

Range of Motion: On active range of motion testing, there was limited forward flexion and abduction to 90 degrees secondary to pain, but full passive motion.

Strength: 5/5 in all shoulder muscles.

Special Testing: Impingement testing was negative. Labral testing was also negative. Cross arm testing was positive.

Palpation: There were no step-offs or crepitus noted. He was tender over the AC joint, along the entire length of the clavicle and over the SC joint.

Neurovascular: The patient's left upper extremity was neurovascularly intact, and there was no palpable lymphadenopathy.

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.


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