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Painting A Picture Of Chronic Shoulder Pain After Clavicle Fracture, A Water-based Solution - Page #1
 

Author: Keenan Barr, DO
Senior Editor: Heather Rainey, MD
Editor: Kiyomi Goto, DO

Patient Presentation:
A 21-year-old male, active-duty military servicemember presented with right shoulder/clavicle pain that has been persistent since a clavicular fracture sustained during a motorcycle accident one and a half years prior.

History:
He was initially treated with non-operative management with a sling for 6 weeks and physical therapy. Follow up plain film imaging showed radiographic healing. He was also evaluated by orthopedics, pain management, and physical therapy who continued to recommend non-operative treatment. He did a trial of gabapentin, duloxetine and tizanidine. He also underwent an injection of the lateral pectoral nerve with pain management that provided partial pain relief. Following the injection he experienced some relief of the superficial clavicular pain but continued to have pain deep in the supra- and infra-clavicular area. The deep pain was exacerbated by backpack wear, running, and sleeping on the right side. He endorsed occasional pain radiating down the anteromedial arm to the elbow with associated burning sensation. He denied any weakness.

Physical Exam:
General: No malaise, generally well appearing.
Inspection: No alignment abnormalities, no bruising, no rashes, no atrophy.
Palpation: Pain over the fracture site of the clavicle and superior to the clavicle at the area of the first rib. This pain radiates laterally down into the shoulder.
ROM: Flexion 180 degrees, extension 20 degrees, abduction 180 degrees, external rotation 90 degrees, internal rotation 25 degrees.
Strength: Deltoid 5 /5, biceps 5 /5, triceps 5 /5, external rotation 5 /5, internal rotation 5 /5
Neurovascular: Sensation intact with normal radial pulses.
Special Tests: Spurling negative, Distraction negative, Wright positive, Adson positive, Costoclavicular positive, Roo�s positive, scapular winging negative, scapular dyskinesis negative, and scapular malrotation negative

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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