Monkey Bar Mishap: A Unique Scapulothoracic Injury And Presentation

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Monkey Bar Mishap: A Unique Scapulothoracic Injury And Presentation - Page #1

Author: Jessica Jewell, MAT Co Author #1: Ryan Baker Senior Editor: Heather Rainey, MD Editor: Nathan Cardoos, MD Patient Presentation: A 5-year-old male presented to clinic with his mother complaining of persistent shoulder girdle pain and dysfunction two weeks after sustaining an injury on monkey bars. History: The mother notes that the patient was playing on the play structure, and his right hand became wedged between two bars. He fell in this position, and his right arm was forced overhead into extreme abduction and traction, causing severe acute pain. Initial evaluation at the urgent care resulted in no definitive diagnosis and prompted referral for evaluation two weeks later with a pediatric sports medicine specialist. Physical Exam: On observation, the patient demonstrated guarding, holding his elbow to his side and avoiding abduction and flexion overhead. Clinical examination demonstrated no erythema, effusion, and relatively symmetric scapulothoracic motion with no definitive scapular winging. Marked tenderness was present at the level of the right inferior scapular angle when compared bilaterally, with no tenderness or pain elsewhere in the shoulder girdle. While no significant strength deficits were observed, a moderate decrease in active forward flexion and abduction range of motion was noted due to pain on the injured side. Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.		Back
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