Is It Just In My Head?

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Is It Just In My Head? - Page #1

Author: Benjamin Rogers, MD Co Author #1: Philip Motley, MD Senior Editor: Drew Duerson, MD Editor: James Robinson, MD, FAMSSM Patient Presentation: The patient is a 21-year-old right-hand dominant collegiate shooting guard who was referred to our orthopedic clinic by her athletic trainer for evaluation of right arm pain. History: Her symptoms began approximately three months prior during an overhead weightlifting maneuver in preseason. Her pain originated in the right shoulder with intermittent radiation posteriorly to her periscapular region and distally to her hand. Her symptoms persisted despite two weeks of conservative management and physical therapy. While continuing to play through the pain during her rehabilitation, her symptoms acutely worsened in the absence of inciting event or injury. At the time of her evaluation, she had been completely out of practice and competition citing progression of her symptoms to headache, nightly pain interfering with sleep, numbness, tingling, and pain refractory to oral anti-inflammatories. Physical Exam: Well-appearing with athletic build. Normal gait. Forward posturing of the neck and bilaterally rounded shoulders. Scapular asymmetry at rest and with wall press. Painless range of motion of the cervical spine without tenderness of the cervical or thoracic spinous processes. Positive Spurling's on the right. Full and symmetric range of motion of the shoulders bilaterally with flexion and abduction to 180 degrees. Painless and symmetric internal rotation to T5. Strength 5/5 with flexion, abduction, empty can, internal/external rotation. Negative Neer, Hawkins, Speed, apprehension, and load and shift tests. Symmetric sensation C4-T1. Symmetric 2+ reflexes at triceps, biceps, and brachioradialis. Negative Hoffmann sign. Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.		Back
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