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Shouldering The Strain: A Cadets Unexpected Weakness Uncovered - Page #1
 

Author: Joshua Calderon, DO
Co Author #1: Geoff McLeod, DO
Senior Editor: Christian Fulmer, DO, FAMSSM
Editor: Christian Fulmer, DO, FAMSSM

Patient Presentation:
A 19-year-old, right hand dominant, female military cadet presented with acute onset of left-sided neck and shoulder pain.

History:
Symptoms occurred 24 hours prior to the office visit without provocation. Pain was described as dull, achy, and localized along the left trapezius and midline back, with radiation to the posterior shoulder. Pain was notably worsened with overhead movements and internal/external rotation of the glenohumeral joint. She expressed difficulty raising the extremity above shoulder height and significant pain while dressing and grooming. Additionally, she noted limited ability to perform push-ups, pull-ups, and bracing in company formation. She denied any history of trauma, fever, systemic symptoms, or prior musculoskeletal injuries involving the neck or shoulder. She recently completed Hell Week during which she performed hundreds of pushups throughout a 7-day period.

Physical Exam:
The patient was well-appearing with normal vital signs. There was no notable muscular swelling or deformity. Palpation revealed tenderness along the left trapezius, levator scapulae, and rhomboids, with notable trigger points in these areas. Active range of motion of the left shoulder was limited in flexion and abduction by pain. External and internal rotation were preserved. Provocative testing revealed a positive Hawkins test and positive O'Brien's test. Strength testing of the rotator cuff muscles was 4/5 and there was notable weakness in the scapular stabilizers. A subsequent sports medicine exam identified lateral scapular winging with active forward elevation and inability to shrug.

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NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.
 

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