Author: Farah Tejpar, MD
Co Author #1: Eric Anish, M.D.
Co Author #2: Jay V. Kalawadia, M.D.
Editor: James Robinson, MD
A 20-year-old college football player presents with left shoulder pain after a tackle.
During a game, a 20-year-old, right hand dominant, quarterback for a Division I football team sustained a tackle from his left side, driving his right shoulder into the ground. He had immediate pain in the left shoulder and walked off the field. He complained of pain and clicking along the inferolateral border of the left scapula that was worse with abduction of the shoulder. A brief sideline exam determined that he was able to return to the game. After two plays, he was tackled again from the left side. He then complained of severe pain in the left scapula and shoulder and was unable to return to play.
On exam, he had no swelling or deformity of the left shoulder girdle. He had full range of motionn of the left shoulder, but scapulothoracic dysrhythmia was evident. He had tenderness to palpation at the sternoclavicular joint, in the left supraclavicular fossa, and along the inferolateral border of the scapula. Strength testing revealed 4/5 strength with external rotation on the left. He had pain at the left SC joint with cross-body adduction. He had FROM of the cervical spine, but lateral bending elicited pain in the posterior shoulder. There was no spinous process tenderness. He was neurovascularly intact in the left upper extremity with pulses and sensation equal to the right side.
Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.