Snap, Crackle, Or Pop? An Under-recognized Cause Of Shoulder Pain In A Young Soldier - Page #1

Author: Benjamin Buchanan, MD
Co Author #1: Benjamin K Buchanan MD
Co Author #2: Jesse P DeLuca DO
Co Author #3: Nicholas Michols DO

Patient Presentation:
A 25 year old active duty male soldier presents with chronic right shoulder pain.

This right hand dominant male describes right posterior shoulder pain that has been progressive in nature after multiple military deployments. The pain is described as diffuse posterior shoulder pain localizing to the medial scapula. There is occasional radiation to the neck. He feels a painful clicking and popping sensation around the medial scapula during shoulder abduction or other actions causing scapular movement or during head rotation. The pain is also exacerbated at night when he sleeps on his shoulder. The pain is described as a constant, dull pain with intermittent exacerbations of sharp pain during the above movements. The pain is typically rated 5/10 but can be as severe as a 7/10. He denies any history of trauma and also denies swelling, stiffness, erythema, or decreased sensation.

Physical Exam:
Right shoulder exam: Inspection: significant for scapular winging, otherwise no swelling, deformities, erythema or atrophy
Range of motion: full active and passive range of motion, audible crepitus and clunk of the scapula against thoracic cage with range of motion, pain elicited with scapular motion
Palpation: tender to palpation over rhomboid, trapezius, levator and cervical paraspinal muscles, no appreciable swelling or warmth.
Neurovascular: 2+ radial pulse, intact sensation to multiple dermatomes distally
Strength: No asymmetrical weakness, 5/5 strength throughout Provocative tests: negative Neer's, Hawkin's, Cross Arm (Yocum), Empty Can, Speed's, Apprehension and Crank.
His cervical spine had normal range of motion. Left shoulder exam was unremarkable.

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