Author: Brian Shafer, DO
Co Author #1: Kevin Burroughs, M.D.
Left shoulder pain
A 25-year old female dermatology nurse presents to the Family Practice Center with a history of left shoulder pain. She reports that her pain started after receiving the influenza A vaccine 3 weeks ago. The pain has been persistent and moderate since. She denies any other injury, but states the pain significantly worsened after moving a desk several days prior to presentation. She states she cannot lift her arm beyond the height of her shoulder without severe pain. She denies any fever or chills. She denies any skin reaction at the site of the injection. She commented “it was the most painful shot I’ve ever gotten.” According to patient, the injection was given using a 1.5 inch needle, which penetrated all the way to the hub when the injection was given.
The patient is afebrile and well-appearing. Her neck shows full AROM and Spurling’s maneuver negative. The patient has painful AROM of the left shoulder with approximately 90° abduction, 60° internal rotation, 80° degrees external rotation. In comparison, her right arm demonstrates 130° abduction, 80° internal rotation, and 100° external rotation. She has positive “empty can” and “full can” supraspinatus testing, positive Speed’s test, positive Neer’s sign, and negative cross-arm test. There is exquisite tenderness to palpation at the lateral aspect of the proximal humerus, consistent with the reported site of the injection. There is no overlying erythema or edema or at the injection site.
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