Author: Nathaniel Tang, BA
Co Author #1: Casey Kohr, DPT, ATC
Co Author #2: Carly Day, MD
Senior Editor: Justin Mark Young, MD
Editor: Elizabeth Rothe, MD

Patient Presentation:
A 22-year-old right-handed baseball pitcher presented with 3 weeks of right shoulder pain.

History:
The athlete first noticed a pulling sensation in his posterior upper arm after throwing a slider. He worked with an athletic trainer/physical therapist on rehabilitation and noted close to 100% improvement over two weeks. Unfortunately, shortly after his pain improved, the right shoulder pain returned, located primarily in the axilla and posterior upper arm. Pain was up to 9 out of 10 and worse with follow through during pitching. He did not recall trauma and denied numbness, tingling, and radicular symptoms. He endorsed occasional neck tightness. The athlete tried diclofenac gel four times a day and continued rehabilitation with no improvement. Oral anti-inflammatories were not recommended due to congenital solitary kidney.

Physical Exam:
Physical examination was notable for full cervical range of motion without pain. There was no tenderness in the shoulder other than at the medial proximal humerus. Bilateral shoulder flexion was 150 degrees, external rotation 70 degrees, internal rotation to T8 and abduction to 160 degrees. There was no pain with active range of motion and there was 5/5 strength without pain during resisted shoulder internal and external rotation, elbow flexion, and empty can. He had mild discomfort with resisted adduction. He had a negative Neer's, Hawkin's, Speed's, and Yergason's and a positive O'Brien's. Distal pulses and sensation were normal.

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.