Author: Nathan Olafsen, MD
Co Author #1: Mark Harrast M.D.
Editor: Jeffrey Brown, MD
The patient is a 23 year old left hand dominant male with two weeks of right shoulder pain.
This developed initially after waking from sleeping in a hammock while backpacking on the Pacific Crest Trail. Pain resolved within a few hours, but recurred and became constant 1 week prior to presentation to clinic. Pain was mild in severity, dull in quality, was located over the right neck, lateral shoulder, and medial to the scapula. Left lateral neck flexion and overhead activities exacerbated pain. Additional symptoms included a sense of fatigue around the right shoulder. He denied numbness, weakness, fever, weight loss, or symptoms in other limbs.
Full bilateral shoulder range of motion was present with pain on the right at terminal flexion and abduction. Sensation and reflexes were intact and symmetric bilaterally in the upper extremities. Strength was 5/5 throughout the bilateral upper extremities, including shoulder shrug and scapular retraction. No muscle atrophy was noted. With resisted shoulder flexion and wall push up, right medial scapular winging was present. No contraction of the serratus anterior could be palpated. There was no lateral scapular winging.
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