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Pull Up Pop - Page #1

Author: Susanna Zorn, MD Co Author #1: Michael W. Moser, M.D. Co Author #2: Jason L. Zaremski, M.D. Senior Editor: Margaret Gibson, MD, FAMSSM Editor: Charles Litchfield, MD Patient Presentation: A 15 year old right hand dominant male baseball player presented to the sports medicine clinic with one week of left shoulder pain. History: He stated the pain began acutely while he was doing pullups and was lowering himself down and felt a pop on the front of his left shoulder. His pain had improved significantly over the course of the interim week but he continued to have pain and weakness, most notable with forward flexion of the shoulder. Of note he also endorsed initiating a workup for a possible connective tissue disorder due to a personal and family history of hypermobility and skin hyper-plasticity. Physical Exam: Inspection: Slight swelling about the left anterior inferior shoulder Palpation: tenderness to palpation along the coracoid, and tendon of the long head of the biceps. Non-tender to palpation over the clavicle, acromion, delto-pectoral junction, or pectoralis tendon. Shoulder range of motion: Flexion 0-180 degrees, abduction 170 degrees, external rotation 70 degrees, internal rotation 70 degrees. Strength: 5/5 abduction, internal and external rotation, 5-/5 shoulder flexion, 5/5 straight arm adduction Sensation: intact to light touch throughout the left upper extremity Special maneuvers: +speeds, +biceps load, -O'brien's, -drop arm, -empty can, -popeye sign Beighton score: 4/9 (5th MCP >90 bilaterally and thumb opposition bilaterally) Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.		Back
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