Right Arm Pain And Swelling In A Competitive Swimmer - Page #1

Author: Amy Hockenbrock, MD
Co Author #1: Michael Henehan D.O.

Patient Presentation:
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.

Physical Exam:
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 Speed’s test. Hawkin’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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