Not Just Another Shoulder Injury - Page #1

Author: Biljinder Chima, MD
Co Author #1: Steven M. Erickson M.D., Head team physcian and fellowship director at ASU.
Co Author #2: Amy Jo Overlin M.D, Facutly and Team Physcian at ASU
Co Author #3: Dianna Padilla ATC, Head ATC Womens Basketball at ASU
Editor: Young Yoon, MD

Patient Presentation:
A 20-year-old ASU Women’s Basketball player presents with the chief complaint of left shoulder pain.

Symptoms began following an injury which occurred while tubing on a local lake. Without warning our patient lost control and was ejected from the tube. She was riding in a supine position and during the accident was flipped such that she was facing the water. Our patient believes that during mid flight her left hand remained in contact with the pull cord. The fall resulted in her arm being forcibly pulled anteriorly overhead from a position of extreme external rotation. A loud “pop” was noted followed by momentary numbness and parathesias down the left biceps. Our patient notes that she felt like her shoulder “popped out and back in”. After the injury, she experienced limited external rotation and an inability to abduct her arm beyond 90 degrees secondary to pain.

Physical Exam:
On examination there was no obvious skin or bony deformities. Tenderness to palpation over the anterior glenoid and biceps tendon was noted. Range of motion was limited to 30 degree of external rotation, 90 degrees of internal rotation, 110 degrees of abduction, and 100 degrees of flexion. A positive apprehension and relocation test was also elicited. There was mild anterior and inferior translation, as well as a positive Horn blower’s sign (case photo 3), Obrien’s, Speed’s, and Yeargson’s tests. Pain was elicited over the lateral shoulder with a cross arm abduction test,yet the Neer’s and Hawkin’s exams were both negative. Strength testing was limited secondary to pain.

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