Author: Simon Moskowitz, DO
Co Author #1: Aaron Lear MD, MSc, CAQ
Senior Editor: Heather Rainey, MD
Editor: Molly McDermott, DO
Patient Presentation:
Patient is a 24-year-old male who presented to the sports medicine clinic with a chief complaint of right shoulder pain. Three days prior to presentation, the patient was participating in a college hockey game when he was checked into the boards from behind with his arm abducted and extended. At that time, he experienced a right anterior shoulder dislocation, which was promptly reduced by the athletic trainer. Since his initial injury, he had been using a sling for support with persistent pain in the posterior aspect of his right shoulder. He stated he has been able to do small pendulum circles, but any active movement about the shoulder resulted in significant pain. He denied any numbness, tingling, or weakness.
History:
His past medical history is significant for previous right shoulder dislocation, last 5-6 years prior, and biopsy-confirmed liver cirrhosis secondary to autoimmune hepatitis. He has been compliant with his current medication regimen, azathioprine and mycophenolate. Notably, he has been on intermittent, chronic steroids for flairs of his hepatitis, starting at age 11, and typically for three months at a time. His last course of steroid use was approximately 4-5 years prior to this injury.
Physical Exam:
Patient was well-appearing, in no acute distress. The right upper extremity was neurovascularly intact. There were no visual abnormalities about the right shoulder. Range of motion and rotator cuff testing was significantly limited secondary to pain. He had tenderness to palpation at the spine of the scapula with minimal tenderness elsewhere. The rest of his physical exam was unremarkable.
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