Author: Bob Klug, DO
Co Author #1: Bob Klug, DO
Co Author #2: Andrew Porter, DO
Senior Editor: Yaowen Hu, MD, MBA
Editor: Jeremy Swisher, MD

Patient Presentation:
The patient was a 16-year-old male that presented to the sports medicine clinic for right shoulder and posterior upper back pain.

History:
The patient developed this pain after being tackled during a football game. He continued to play in the game and did not think much about it. After the game, the pain persisted, which prompted a visit to the Emergency Department for further evaluation. X-ray revealed a first rib fracture but the provider stated that this was an old fracture which confused the family since he did not have any history of a prior injury. The patient followed up with his primary care physician who recommended keeping the patient out of contact sports until evaluated by the sports medicine team. He was 3 weeks and 5 days out from the original injury upon his evaluation with sports medicine.

Physical Exam:
General: No acute distress.
Neck: Trachea midline. Full range of motion of the cervical spine. No tenderness to palpation of the spinous processes.
Lungs: Clear to auscultation bilaterally. No wheezes, crackles, rales, or ronchi were appreciated.
Right Shoulder: No tenderness to palpation over the sternoclavicular joint, clavicle, or acromioclavicular joint. There was tenderness to palpation over the first rib with deep palpation. The patient had full active and passive range of motion of the right shoulder, but he did have pain with flexion and abduction. There was five out of five strength of the deltoid and rotator cuff muscles.
Neurovascular: Pulses and sensation intact bilaterally.

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