Puzzling Periscapular Pain - Page #1

Author: Kiyomi Goto, DO
Co Author #1: Kathryn Gloyer
Senior Editor: Mandeep Ghuman, MD, FAMSSM
Editor: Allison Schafer, DO

Patient Presentation:
19 year old female rugby athlete with 9 days of left posterior shoulder and periscapular pain.

A 19 year old female rugby athlete presented to the training room for evaluation of 9 days of left posterior shoulder and periscapular pain.
She had performed a tackle with her left shoulder during a contact drill then immediately experienced sharp pain in the the ipsilateral shoulder.
Pain increased with shoulder movement and deep inspiration.
She denies neck pain, upper extremity paresthesias or weakness.

Physical Exam:
On examination, the bony landmarks of the cervical spine are nontender.
She has full and painless range of motion of the cervical spine.
She has localized pain in the neck with Spurling maneuver but no radicular pain.
She has a slightly kyphotic posture.
On shoulder exam, she has a mild deficit in forward flexion and abduction due to pain, but special testing was unremarkable.
She has tenderness over the rhomboid and levator scapulae as well as the lower border of the trapezius.
There is appreciable hypertonic musculature of the scapular stabilizers.
She has 5/5 strength throughout the bilateral upper extremities.
Her distal neurovascular exam is intact in the upper extremities.

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