Battered And Bruised: A Rare Cause Of Thoracic Pain In A Division One Offensive Lineman

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Battered And Bruised: A Rare Cause Of Thoracic Pain In A Division One Offensive Lineman - Page #1

Author: Graeme Marquez, MD Co Author #1: Robert Felix, MD Senior Editor: Kristine Karlson, MD, FAMSSM Editor: Kirsten Schneider, MD Patient Presentation: Acute right anterior chest and shoulder pain History: A 20-year-old division one offensive lineman complained of acute right anterior shoulder and upper chest pain during a football game. He had been struck in the chest and shoulder by the helmet of an opposing player. He was initially unable to move his right arm. The symptoms rapidly improved and he was able to complete the game with some discomfort. Pain was described as focal and sharp located in the right mid-clavicular region that worsened by bringing his arm across his chest. He also noted associated anterior chest wall bruising. He took ibuprofen with mild relief of pain. He denied any focal weakness, numbness, paresthesia, shortness of breath, shoulder instability, lightheadedness, or palpitations. The following day, he was able to complete practice and weight-lifting with minimal pain. Physical Exam: General: Comfortable and in no cardiopulmonary distress. Musculoskeletal: Area of ecchymosis noted in the right mid-clavicular region. Normal active and passive range of motion to the right shoulder. Normal scapular range of motion without winging. Tenderness to palpation at mid-clavicle. No tenderness to acromioclavicular joint, sternoclavicular joint, long-head of biceps tendon, or rotator cuff muscles. Neurologic: Strength 5/5 to shoulder flexion, extension, internal rotation, external rotation, shoulder abduction and adduction. No sensory deficits. Radial and ulnar pulses palpable. Special tests: Rotator cuff testing within normal limits. Positive scarf test on right. Negative resisted right acromioclavicular joint extension. Biceps testing negative. Negative shoulder instability. Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.		Back
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