Pediatric Shoulder Pain: An Uncommon Etiology - Page #1

Author: Thomas Stocklin-Enright, DO
Co Author #1: Dr. John O'Malley
Editor: Alyssa Mixon, DO
Senior Editor: Alyssa Mixon, DO
Editor: Margaret Gibson, MD, FAMSSM
Senior Editor: Margaret E Gibson, MD

Patient Presentation:
12 year old right-hand dominant male with no significant past medical history presented with left shoulder pain following traumatic fall 11 days prior. He was tackled onto uneven dirt ground with direct impact to his lateral left shoulder with arm adducted. He denied previous injury. Immediately following the event, he presented to the emergency department where X-Rays were negative for acute fracture. He was discharged home with a simple sling, NSAIDs, and told to follow up in 1-2 weeks.

Since the event the patient "cannot move" his left shoulder due to sharp, non-radiating pain and associated weakness. Exacerbating factors include movement of the left upper extremity. Palliative measures include ice, rest, and sling immobilization. He denies fevers, clicking, popping, catching, or crepitus of the left shoulder.

No significant past medical history.

Physical Exam:
VS: Stable
Gen: WDWN, in NAD
Resp: CTAB
Derm: Intact without erythema
Symmetric shoulder contour without visual or palpable atrophy noted in shoulders bilaterally. No scapular winging. +Proximal humerus tenderness to palpation laterally on left. The AC joint, clavicle, biceps tendon are all non-tender to palpation. Radial, ulnar, and brachial pulses are all 2+ and intact bilaterally. Strength is limited to 2/5 in flexion and external rotation in left upper extremity, internal rotation and extension are 5/5. Active range of motion limited to 25 degrees abduction, 25 degrees flexion, 20 degrees external rotation. +Empty can test on the left. Subscapularis lift-off, apprehension, sulcus sign, hawkins all negative/equivocal. DTRs +2 bilaterally in upper extremity. Gross sensation is intact bilaterally in the upper extremity. Cervical/thoracic exam unremarkable as is distal upper extremity bilaterally.

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