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Something To Shoulder: A Case Of Abnormal Shoulder Range Of Motion In An Adolescent - Page #1
 

Author: Jayla Bostic, DO, MS
Senior Editor: Justin Mark Young, MD, FAMSSM
Editor: Katlyn Elliott, MD

Patient Presentation:
15-year-old male presenting with a long-standing history of abnormal right shoulder movement presented for routine wellness visit and reported a long-standing history of abnormal right shoulder movement. He noted that his right shoulder has "always felt different," but symptoms became more noticeable after he started weightlifting 1.5 years ago. He has no pain at rest, but experiences 4/10 discomfort during shoulder presses and lateral raises. He is also unable to lift his right arm above his head without tilting his torso or shrugging his shoulder up first. He endorses some weakness in the right shoulder and arm, but denies neck pain, numbness, or tingling. No history of trauma or injury to the right shoulder. He denies any similar complaints of his left shoulder. Of note, the patient was born full term without history of birth injury. Parents did not notice any right arm or shoulder deformities when he was younger.

History:
Past medical history notable for eczema.
Family history is remarkable for "some muscular issue" in maternal uncle, who follows with a neurologist.

Physical Exam:
Inspection: Medial border of the right scapular appears more prominent than left. No muscular atrophy appreciated.

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Neurovascular: Sensation grossly intact and pulses present bilaterally.

Palpation: Unremarkable.

Right shoulder ROM: Flexion limited above 90° and abduction limited above 90°. Requires shoulder shrug to initiate movement and demonstrates scapular compensation.

Motor function: 5/5 throughout.

Provocative tests: Positive wall push-up with scapular winging on the right.

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.

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

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