Author: Nicholas Tsitsilianos, MD, MS
Co Author #1: Kathryne Bartolo, MD
Co Author #2: Dr. Christopher Visco, MD
Senior Editor: Marc Hilgers, MD, PhD, FAMSSM
Editor: Kevin Gray, MD

Patient Presentation:
16 year old right hand dominant pitcher with pain in his throwing arm while pitching for the past 4 weeks.

History:
A 16-year-old male pitcher with no PMH presents with right arm pain while pitching that began 4 weeks prior to his initial visit. He noted progressive difficulty generating force while pitching and a decrease in his throwing speed. Had rested for 2 weeks and was feeling slightly better. Pain was located in the anterior right shoulder and associated numbness and tingling in the right thumb and 2nd digit. He rated his pain as a 1/10 in the office but 7/10 with throwing, laying on the right side, or stretching the arm in full extension, also noting that his arm feels heavy, “like a loose noodle”. He had mild upper respiratory infection symptoms during summer prior to initial visit

Physical Exam:
Observation: Well appearing, in no acute distress. Atrophy on the right pectoralis major clavicular head. Right scapular dyskinesia
Palpation: TTP on the right coracoid process. No TTP on the subacromial space, biceps tendon long head, AC joint or periscapular muscles
Range of Motion: Full and painless bilateral range of motion with no instability or crepitus noted
Sensation: Normal sensation to light touch in bilateral upper extremities
Special Tests: + Median neural tension sign
Manual Muscle Testing: 5/5 strength in right shoulder abduction, elbow and wrist extension, finger flexion and finger abduction. 4/5 strength in right shoulder external and internal rotation and elbow flexion

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