Can't Shrug This Shoulder Pain -- Not Your Typical Overuse Injury

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Can't Shrug This Shoulder Pain -- Not Your Typical Overuse Injury - Page #1

Author: Karen Reynolds, MD, PT, DPT Co Author #1: Jordan Hilgefort, MD, MBA Co Author #2: Justin Chu, MD Co Author #3: Brittney Richardson, MD Senior Editor: Kristine Karlson, MD, FAMSSM Editor: Jennifer Gaitley, MD Patient Presentation: A 20-year-old male collegiate swimmer with a past medical history of prior left shoulder instability presented with right shoulder pain. History: The patient described the pain as worse during backstroke, overhead movements, and when turning to the right to breathe on freestyle. His pain felt deep inside the shoulder, but he also experienced anterior pain when reaching overhead. He had been doing rehabilitation and avoiding overhead exercises, but his pain persisted. Six weeks after initial presentation he returned with right shoulder pain and swelling, along with intermittent numbness in his biceps. Physical Exam: The patient was afebrile, heart rate was 72, respiratory rate was 16, and blood pressure was 160/77. Oxygen saturation was 100% on room air. On inspection there was swelling of the right shoulder and chest with apparent venous distention present; left shoulder examination was notable for chronic hypertrophic scar. No gross deformities, ecchymosis, erythema, or abrasions. Musculoskeletal exam showed normal active and passive range of motion of bilateral arms and shoulders, neurovascularly intact, 5/5 strength bilaterally. Negative Jobe's, drop arm, Speed's, Yergason's, Neer's, Hawkins, apprehension/relocation, jerk, load, and shift, sulcus sign, crossbody adduction. Positive O'Brien's and tender to palpation over the right bicipital groove. Case Photo #1 Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.		Back
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