Author: Eric Swanson, MD, MSc
Co Author #1: Benjamin May, MD - Department of Orthopedic Sports Medicine, Baylor Scott and White Memorial Hospital, Temple, TX
Co Author #2: Taras Ploskanych, MD - Department of Physical Medicine and Rehabilitation, Baylor Scott and White Memorial Hospital, Temple, TX
Senior Editor: Kevin Gray, MD
Editor: Andrew McBride, MD

Patient Presentation:
A 17-year-old, right-handed female with no relevant past medical history initially presented to the sports medicine clinic with diffuse left arm pain, weakness, paresthesia, and inability to lift her shoulder above 80 degrees after sustaining an overhead sports-related injury during a high school basketball game three days prior. Her symptoms presented immediately after her arm was hyper-flexed and laterally rotated while attempting to collect a rebound. Upon initial evaluation, she was prescribed conservative management with strict advice to cease returning to sport.

History:
Four days later, her initial symptoms completely resolved, and she fully regained her range of motion. She resumed basketball practice without medical clearance. She then experienced a second minor collision with another player, mildly impacting her left anterior shoulder. Her symptoms immediately returned.

Physical Exam:
Vitals: afebrile, heart rate 56, blood pressure 122/77
Neck: Mild tenderness to palpation over posterior neck muscles. Slightly decreased cervical spine range of motion in all directions with pain at endpoints of rotation. The Spurling test was negative.
Musculoskeletal: Significant winging of the left scapula with medial displacement of the lower angle and lateral displacement of the upper angle. Limited active and passive movement in the left shoulder with the inability to abduct the shoulder greater than 80 degrees.
Neuro: Strength Left upper extremity is 4/5 in deltoid, bicep, triceps, and wrist extension. Otherwise, 5/5. Deep tendon reflexes 2+ bilaterally. Sensation decreased to light touch over the left upper extremity in a patchy distribution.

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