Author: Amy Hockenbrock, MD
Co Author #1: Michael Henehan D.O.
Editor: Anthony Kohlenberg, MD
A 19 year old female presented to the training room with three days of anterior right shoulder pain.
Her initial pain was described as a heaviness that worsened with extreme extension and biceps contraction. She stated that her pain began after her coach applied a compression band for biceps friction therapy. She was diagnosed with biceps tendinitis and started on anti-inflammatory medications. Three days after the initial diagnosis she returned to clinic with worsening pain, swelling, and heaviness in the same right anterior shoulder distribution.
On general exam, she was in no acute distress. She was alert and oriented to person place and time. Her cardiac exam revealed a regular rate and rhythm without murmurs, rubs or gallops. Her respiratory exam was normal without rales, rhonchi or wheezing. Her right upper extremity had a radial pulse of +2. She had full strength of her proximal and distal extremities. There was normal sensation. Noteworthy findings included tenderness to palpation over the right anterior bicipital tendon with a positive Speedâ€™s test. Hawkinâ€™s, Cross Arm and Apprehension tests were normal. The circumference of right upper extremity at mid-biceps was 2 cm greater than the left. The circumference of the right upper extremity 8 cm distal to the antecubital fossa was 1.5 cm greater than the left. A varicosity was visible in the right axilla. There were no visible varicosities in the left axilla. There was no change in symptoms with complete abduction of right arm.
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