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Sternoclavicular Joint Pain In A Cyclist - Page #1
 

Author: Audrey Potts, MB, BCh, BAO
Co Author #1: Suzanne Hecht, MD, CAQ, CCD
Senior Editor: Justin Mark Young, MD, FAMSSM
Editor: Chelsea Cole, MD

Patient Presentation:
A 37-year-old right-handed cyclist presented to clinic five days after falling off of her bike on her right shoulder and wrist.

History:
The patient did not recall the exact mechanism of impact to the ground. She endorsed sharp pain in her posterior shoulder around the infero-medial scapular border when doing a backstroke-like motion, and vague tightness around the sternal area with reaching forward and twisting her torso. She denied neurological symptoms, neck pain, weakness, dysphagia or cough. She had never injured her shoulder or upper body before. At her first follow-up visit, her posterior shoulder pain improved but she endorsed more localized sternum pain and pleuritic chest pain with exertion. She denied shortness of breath, chest heaviness, palpitations, pre-syncope or syncope.

Physical Exam:
General: No distress
CV & Lungs: lungs were clear to auscultation and her cardiovascular exam was normal.
Inspection: focal swelling notable over her right sternoclavicular (SC) joint
Palpation: tender to palpation over the SC joint and the rhomboids at the medial scapular border.
ROM: full and pain free in abduction, flexion, and external rotation. Mild pain in the infero-medial scapular border at the end range of internal rotation.
Special Tests: Pain over infero-medial scapular border with resisted internal rotation and abduction, posterior apprehension and crossed body abduction. Negative: Jobe's, drop arm/painful arc, lift-off, Spurling's.
Neurologic: 5/5 strength in shoulder abduction, forward flexion, external rotation and internal rotation. Sensation intact to light touch in bilateral upper extremities.

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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