Silent Killer - Page #1

Author: Adam Colen, DO
Co Author #1: Adam Colen D.O.
Co Author #2: Michael Miller M.D.
Editor: James Rory Tucker, MD

Patient Presentation:
20 year old male presents with 3 weeks of right shoulder discomfort.

He describes the discomfort as a pinching sensation and points to this right periclavicular region. He states that it seems worse with overhead maneuvers. He also explains that over the last seven days he has noticed an associated diffuse progressive right upper extremity swelling and bluish discoloration to his arm. He denies a recent a history of trauma but does state an increased amount of Frisbee golf over the last 4 weeks. Lastly, he states that he was evaluated in the ED 2 days ago with a negative venous duplex ultrasound.

Physical Exam:
Increased girth, with slightly bluish hue and engorgement of superficial veins of the right arm compared to contralateral.Case Photo #1, Case Photo #2, Case Photo #3 No pitting edema, warmth, or tenderness. Full ROM of shoulder with increased pain to extremes of abduction and external rotation. 5/5 strength to resistance throughout. 2/4 radial pulse. Sensation intact to light touch, 5/5 strength median, ulnar and radial nerves. Negative Adson's and provocative tests.

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