Author: Gabrielle Ahlzadeh, MD
Co Author #1: David Rothberg, MD, University of Utah Department of Orthopedics
Co Author #2: Stuart Willick, MD, University of Utah Division of Physical Medicine and Rehabilitation
Senior Editor: Kristine Karlson, MD, FAMSSM
Editor: Heather Rainey, MD

Patient Presentation:
A 17-year-old football running back with no significant past medical history presented to clinic with one day of left shoulder pain that started acutely during a football scrimmage.

History:
The injury occurred when he was running and got tackled, landing on his left shoulder with a 300-pound defensive player on top of him. He localized his pain to the medial aspect of his left clavicle with some muscle tightness on the left side of his neck. He had trouble sleeping because of the pain. He presented to a local emergency room on the day of injury. Radiographs were obtained. He was told they were normal, was placed in a sling and discharged from the emergency room. He presented the next day to the Sports Medicine Clinic. He denied any numbness, tingling or pain radiating down the affected limb. He denied any other injuries. He is right hand dominant.

Physical Exam:
Height: 172.7 cm
Weight: 70.3 kg
BMI: 23.6

General: A well-developed young man in obvious pain.

Extremities: Examination of the left shoulder revealed mild swelling in the region of the left sternoclavicular joint with tenderness to palpation. The proximal left clavicle was difficult to palpate but the middle and distal portions were palpable without tenderness. There was no tenderness over the muscles around the left neck, the distal end of the clavicle, the acromioclavicular joint, the acromion, the scapula, or the periscapular muscles. There was no tenderness over the anterior, lateral or posterior aspects of the humeral head. There was no tenderness over the cervical or thoracic spinous processes. Neck motion was limited with a report of left anterolateral neck muscle tightness. Neck extension was limited more than flexion. Distally in the left upper limb, there were no strength, sensory, vascular or motion deficits around the elbow or wrist. With resistance testing around the shoulder, he was limited by pain but activating all muscles. He was guarding with passive and slow active motion of the left glenohumeral joint without motion restriction. There was no glenohumeral joint instability.

Gait: Normal

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