Author: Tanner Eiben, DO
Co Author #1: Dr. Patrick Smith, MD
Senior Editor: Kristine Karlson, MD, FAMSSM
Editor: Ryan Reese, DO
The patient is a 15-year-old left hand dominant male with history of bilateral congenital anomalous thumb malformations who presented to a primary care sports medicine physician two days following a left shoulder injury. The patient was making a tackle in a high school football game when he described a forceful abduction and external rotation of the left shoulder. This caused an anterior shoulder dislocation. An emergency medicine physician was attending the game and reduced the patients shoulder. He presented to clinic for evaluation after dislocation. He never dislocated his shoulder previously.
Past medical history: Hypothyroidism, controlled asthma and bilateral anomalous thumb malformations
Past surgical history: None
Family history: Mother reported epilepsy and had been on divalproex sodium with folic acid during her pregnancy with the patient
Medications: Levothyroxine 75 mcg daily, Albuterol sulfate inhaler 2 puffs as needed
Allergies: No known drug allergy
General: Well developed, well nourished
Hands: Bilateral thumb hypoplasia with distal displacement of the thumb bases and underdevelopment of thenar eminences Case Photo #1 Case Photo #2
Neuro: DTRs 2+ in bilateral upper and lower extremities. Normal sensation over bilateral deltoid
Beighton score: 4/9 (negative)
Active range of motion: flexion 180 degrees, abduction 110 degrees, external rotation at side 25 degrees, external rotation with abduction to 85 degrees with pain and apprehension
Rotator cuff strength 5/5
Special tests: O'Brien's positive, trace sulcus sign, load and shift grade 3, apprehension positive, relocation positive
Normal range of motion and strength
Load and shift grade 2
Trace sulcus sign
Reported physical exam was from 21 days after initial injury. His initial physical exam was limited due to patient apprehension and pain.
Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.