An Unusual Case Of Shoulder Pain In An Adolescent Athlete

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An Unusual Case Of Shoulder Pain In An Adolescent Athlete - Page #1

Author: Meghan Caballero, MD Co Author #1: Dr. Kimberly Hornbeck, MD Senior Editor: Heather Rainey, MD Editor: Bernadette Pendergraph, MD Patient Presentation: 15-year-old male baseball pitcher and football quarterback with known bilateral scapular winging presented to the sports medicine clinic for 6 weeks of right shoulder pain. History: His shoulder pain was aggravated by throwing and improved with relative rest. He noted a decreased range of motion (ROM) associated with his scapular winging, which had caused him to change his throwing mechanics. He denied neurological symptoms in his upper extremities. He had been actively participating in physical therapy (PT) for his scapular winging for 6-7 months which improved his winging slightly, per dad, but provided no relief of his shoulder pain over the weeks during which they were working on it. The athlete was very compliant with his home exercise program. Physical Exam: Inspection revealed bilateral scapular winging Case Photo #3 , loss of cervical lordosis, underdeveloped trunk muscles Case Photo #2 , and over developed trapezius muscles Case Photo #1 . He was nontender over the clavicle, acromioclavicular joint, deltoid, upper trapezius, supraspinatus, periscapular region, and cervical/thoracic paraspinal musculature. He had no sensory deficits. He had limited ROM with shoulder forward flexion and abduction and required arm swinging to get momentum for shoulder flexion greater than 90 degrees Case Photo #4 . Shoulder internal and external rotator cuff strength was 5/5 but that of periscapular muscles was 2-/5. Special tests for rotator cuff injury and intra-articular shoulder pathology were negative. Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.		Back
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