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Don't Be A Good Samaritan - Page #1
 

Author: Hasan Naserdean, MD
Senior Editor: Yaowen (Eliot) Hu, MD, MBA
Editor: Ruikang (Kong Kong) Liu, MD

Patient Presentation:
24-year-old male presents with acute left shoulder pain after injury.

History:
Patient was at work when he noticed a large male steal something. The patient pursued the perpetrator and attempted to hold him down by jumping on his back. The perpetrator fell backwards with patient on his back and landed on the patient's left shoulder. Immediately, the patient experienced sharp pain to the left shoulder, worse with any range of motion and palpation. Patient took 1000mg of acetaminophen without improvement of symptoms. On presentation, patient complained of pain in the left shoulder that was 7 out of 10 and denied pain in any other extremity or joint. Patient also denied headache, loss of consciousness, emesis, loss of memory, neck pain, back pain, chest pain, shortness of breath, abdominal pain, pelvic pain, paresthesia, and focal neurological deficits.

Physical Exam:
Patient's head was atraumatic, and he had no midline tenderness along the entire spine. There was no tenderness to chest palpation and lungs were clear bilaterally. His left arm was flexed, adducted, and internally rotated with no obvious bony abnormalities. There was tenderness along the spine of the scapula and acromion and range of motion of the left shoulder was decreased. There were no motor or sensation deficits, peripheral pulses were strong and equal in all extremities, and skin was intact, warm, dry and without tending. The rest of his elbow, wrist and hand were unremarkable.

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.

NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.
 

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