Chronic Shoulder Pain In An Ultimate Frisbee Athlete - Page #1

Author: David Ross, MD
Co Author #1: Arsh Dhanota, MD, CAQSM

Patient Presentation:
The patient is a 24 year old male who presented to clinic with a complaint of right shoulder pain for 2 years.

He sustained the shoulder injury while participating in an Ultimate Frisbee game two years ago. He described the mechanism of injury as forced extension while striking the back of another athlete. He had intermittent pain until the last two months, when the pain intensified and became constant. The pain was characterized as a 5/10 and was initially localized anteriorly, but then moved to be primarily posterior. The pain was associated with a sense of weakness. The symptoms were aggravated by overhead reach, cross body activity and lifting above his head. He occasionally felt clicking in his shoulder, but did not feel instability or decreased range of motion. He had no previous injuries.

Physical Exam:
On inspection of the right shoulder, there was no swelling, ecchymosis or scapular winging.
Atrophy of the right infraspinatous muscle bulk was noted.
On range of motion testing, the patient had full motion on forward flexion, abduction, cross body adduction and internal rotation. However, on external rotation, the patient had limited range of motion on the right side. Furthermore, on the Apley scratch test, the patient had limited range of motion on the right side.
In terms of muscle strength, the patient was weak with external rotation: 4/5 and painful on the right side. There was no tenderness to palpation over any of the bony landmarks or muscle tendons.
The patient was noted to be positive for both Hawkins and Neers testing, and negative for Mayo Shear and O'Brien's testing.
The patient's right upper extremity was otherwise neurovascularly intact.

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