Author: Alan Shahtaji, DO
Co Author #1: Jessica Stambaugh, BS
Editor: Christine Persaud, MD
Senior Editor: Marc P. Hilgers, MD, PHD
Our patient is a 35 year-old right hand dominant Indian male who originally presented to his primary care physician for newly diagnosed Type 2 Diabetes. On review of systems, he was found to have progressive right greater than left proximal upper extremity weakness of insidious onset over the preceding six months. He denied any inciting event, instead simply noticing weakness upon lifting luggage into an overhead aircraft compartment. He described an inability to lift his right arm above shoulder level, requiring momentum to propel his arm overhead while playing tennis. He denied any pain, sensory changes, or other areas of weakness.
Past Medical History was notable for recently diagnosed medication controlled Type 2 diabetes. Family and Social History were non-contributory.
Physical exam was significant for an obese male with right scapular winging. A soft, non-tender fullness was palpated in the right supraclavicular fossa. Fatty atrophy was noted in the right greater than left shoulder girdle musculature. Range of motion testing of the right shoulder demonstrated limited active forward flexion and abduction above ninety degrees despite full and painless passive range of motion. He achieved full motion using accessory muscles, albeit transiently before his arm dropped to his waist. Strength 4/5 was noted in forward flexion, extension, abduction, and adduction. Deep tendon reflexes were trace at triceps and normal at biceps and brachioradialis. Impingement, drop arm, and crossover testing were negative.
Case Photo #1
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