The Volleyball Player Who Could Not High-five! - Page #1

Author: Gina Pontius, MD
Co Author #1: James M. Daniels, MD, MPH
Co Author #2: Erica Miller, PA-C
Editor: Young Yoon, MD

Patient Presentation:
19 y/o female college volleyball player who presented to the training room with 4 weeks of right anterior shoulder pain, especially with certain types of overhead activity.

No history of a specific injury.
Hitting and Serving bother her the most. Setting and Passing do not seem to bother her as much. Complains that she cannot “high five” with her teammates.
She is also a power lifter in her spare time and spends a lot of time in the weight room. She has been unable to bench press and do push-ups because of the pain.
No history of shoulder problems in the past.

Physical Exam:
Very muscular female with shoulders in a hunched over position.
Tender to palpation over the anterior aspect of the shoulder.
Very tender over the coracoid.
Nontender over the AC and SC joints.
Pain, especially with forward flexion, medial rotation, and adduction and at the end of abduction.
Yergason’s and Speed’s tests negative.
Cuff muscle testing demonstrates normal strength, pain with internal rotation.
No atrophy of supraspinatus or infraspinatus noted. Nontender over the suprascapular notch.
Hawkin’s and Neer’s tests positive.
Obrien’s and labral grind test negative.
Scapular dyskinesia is noted.
Roos testing for thoracic outlet is negative. Sternocleidomastoid normal bilaterally, pectoralis minor tightness noted on exam bilaterally.
Normal neck exam, negative Spurling’s, normal upper extremity reflexes and sensation.
Weakness in core muscles noted.
Positive lift off test and trendelenberg test.

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