Author: George Liras, DO, MS
Co Author #1: Sarah Abdellatif, DO
Co Author #2: Jocelyn Szeto, MD
Co Author #3: Rehal Bhojani, MD
Senior Editor: Joseph Chorley, MD
Editor: Justin Mark Young, MD
An 18-year-old right hand dominant male with no significant past medical history presented to the clinic for evaluation of right upper back and chest wall pain after an injury.
The initial injury was 2 weeks prior to the office visit. The patient reported a popping sensation followed by a sharp pain in the upper back area while overhand spiking a ball during Spikeball. The pain radiated around the rib cage and into the upper chest. Pain was exacerbated by coughing, sneezing, and deep breathing. Patient tried over-the-counter NSAIDs as well as rehabilitation program by his school's athletic trainer for trapezius strain without relief. Patient also noted a drop of his shoulder and difficulty moving his arm.
Physical examination revealed right scapular winging and shoulder drop with tenderness over the pectoralis major, latissimus dorsi, right trapezius , right rhomboid, and thoracic paraspinal muscles. Right triceps strength was 4/5 along with weakness on shoulder shrug. Spurling's test was negative bilaterally. Drop arm sign was positive on the right. The patient's strength was 5/5 for supraspinatus, infraspinatus, subscapularis, Biceps and Deltoid bilaterally. No atrophy, prominent AC joint, prominent SC joint were appreciated.
Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.