Surgical Stinger - Page #1

Author: Seth Schmoll, DO
Co Author #1: Michael DaRosa, DO
Editor: Shaun Spielman, MD

Patient Presentation:
A 16 year old previously healthy male defensive back was called off the field in the 4th quarter of a varsity football game for injury check after complaining of left arm numbness.

Four plays prior the athlete sustained a hit to his left shoulder and helmet while being blocked by the opposing wide receiver, causing a quick right sided bending and rotation motion to his upper torso. He got up immediately after the play, shook out his neck and returned to the defensive huddle. He continued to play at a high level without any major contact. After being walked over to the sideline he reported that his left arm numbness had resolved. He did complain of moderate left neck and shoulder pain as well as new numbness over his left upper quadrant and left lateral rib cage. He denied any weakness, dizziness, headache, chest pain, shortness of breath, or abdominal pain.

Physical Exam:
Gen: A&Ox3, NAD, sitting comfortably on exam table.
HEENT: Normocephalic, atraumatic.
Neck: No midline tenderness. Mild tenderness to palpation over left paraspinal muscles, ROM full, end ROM exacerbated his left paraspinal pain. Upper extremity muscle strength and sensation normal and equal bilaterally. Negative Spurling test.
Pulm: LCTA B/L, no wheezes, rhonchi, or rales.
CV: RRR no murmur, rub, or gallop.
Left Shoulder: TTP over left trapezius muscles. Normal ROM, muscle strength, and sensation. Negative Neers/Hawkins, Cross Arm and AC load, O'Briens, Speeds and Yergasons tests.
Thoracic spine/Chest Wall: Thoracic spine non TTP. Anterior and lateral Rib compression produced LUQ abdominal pain. Gross thoracic ROM caused LUQ abdominal pain.
Abdomen: Normal inspection without ecchymosis. BS X4. Non distended. TTP over LUQ. Abdomen Rigid with Guarding and Rebound tenderness present. No flank tenderness to percussion.
Skin: No rash, erythema, or ecchymosis.

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NOTE: For more information, please contact the AMSSM, 11639 Earnshaw, Overland Park, KS 66210, (913) 327-1415.

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