Author: Blair Becker, MD
Co Author #1: Blair Becker, MD
Co Author #2: Jordan Chun, MD

Patient Presentation:
33 year old right hand dominant male presents with recurrent shoulder pain.

History:
The patient is a former national-level player in his native Mexico and played competitively between the ages of 7 and 25, winning 2 national championships. During his career he developed chronic right anterior shoulder pain that interfered with the cocking and acceleration phases of serving and spiking.
The patient commented that as a shorter player he tended to twist his arm in unusual ways to find a better angle to avoid blockers. Occasionally he had the sensation of instability, but without frank subluxation or dislocation.
His symptoms ultimately forced him into retirement 8 years ago without a clear diagnosis.
While attempting to return to volleyball a few months prior to his presentation, he noted a recurrence of this same shoulder pain, as well as some discomfort with overhead shoulder presses. He denied weakness, though he admitted to decreased muscle mass in his right upper back, purportedly since his youth.

Physical Exam:
Ht 6’ WT 178 lbs
General: alert, oriented, in no acute distress
Musculoskeletal: significant atrophy of the infraspinatus on the right
-Both active and passive range of motion are full and without pain
-Mild scapular winging, bilaterally
-Strength to isometric manual testing is 5 out of 5, except for 4/5 shoulder external rotation on the right
-Jobe’s test, Drop test, Posterior Lift-off, Speed’s, Yergason’s tests are negative on the right
-Positive Neer’s, negative Hawkin’s and cross-body adduction on right
-No bony or soft tissue tenderness to palpation
-No glenohumeral laxity or instability

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