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Double Trouble: Persistent Shoulder Pain In A Young Female - Page #1
 

Author: Sessen Dudek, MD
Co Author #1: Amanda Honsvall Hoefler, MD
Senior Editor: Drew Duerson, MD
Editor: Moneeb Akhtar, MD

Patient Presentation:
A 29-year-old female with no history of prior shoulder injury presented with right shoulder pain.

History:
The patient reported nine months of pain located over the anterior and posterior aspect of the right shoulder, scapula, and neck. The pain was described as throbbing and aching, with intermittent tingling to the hand. The pain improves with rest and was aggravated by activities including heavy lifting, desk work, driving, video games, and running. The symptoms also occurred at night while sleeping. Additionally, she reported shoulder weakness and a sensation of heaviness. She denied any skin color changes or hand weakness.

Previous treatment included rest, activity modifications, over-the-counter pain medications, and previous formal physical therapy with ongoing home exercises. These conservative measures di not improve her symptoms.

Physical Exam:
Vital Signs: Height 5 foot 0 inches, Body Mass Index 24.

Right Upper Extremity: No atrophy or erythema.
Palpation: Tender to Palpation at the proximal biceps tendon, anterior and posterior glenohumeral joint lines, scalene, pectoralis, and scapular stabilizer musculature.
Range of motion: Flexion: 180 degrees, Abduction: 180 degrees, External Rotation: 80 degrees, Internal Rotation: T6.
Strength: Internal and External Rotation 5-/5. Abduction 5/5.
Special tests: Positive Neer, O'Brien's, Yergason, and Speed tests. Equivocal Crank and Kim tests. Hawkin's negative. Positive Adson, Roos, Cubital Tunnel Tinel, Radial Tunnel Tinel, Carpal Tunnel Tinel and Phalen tests. Negative Spurling's test.
Neurovascular: Radial pulses 2 plus. No sensory deficits.

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.

NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.
 

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