Author: Nicholas Downs, DO
Co Author #1: Jill Moschelli, MD, MBA
Senior Editor: Jessalynn Adam, MD
Editor: Andrew McBride, MD

Patient Presentation:
The patient was a 28 year old female who presented for left shoulder pain, weakness, and some instability.

History:
She reported that the pain started while she was playing soccer in 2006. She mentioned multiple subluxation events. She was evaluated at an outside hospital and had X-rays done that were unremarkable per the patient. She did not do any formal physical therapy at that time. She was able to get back to sports.

She recently started weight lifting and mentioned sensation of weakness in the left shoulder with certain movements as well as a painless "clunking". Also, she described a "dead arm" type feeling when she had her shoulder in internal rotation behind her back. She otherwise denied numbness or tingling. She denied nocturnal pain symptoms. She denied new injury. She did take ibuprofen 600mg on occasion for pain.

She was up to date on childhood vaccinations and had no recent medical changes. She recently received COVID-19 vaccination.

Physical Exam:
LEFT SHOULDER
Inspection: There was no swelling, ecchymosis or gross deformity appreciated.
Palpation: There was no tenderness to palpation along the clavicle, acromioclavicular joint, biceps insertion, or humerus.
Range of motion: Abduction 180 degrees, Forward flexion 180 degrees, Extension: 50 degrees, External Rotation 90 degrees, Internal rotation to 9th thoracic vertebrae.
Special Tests: She had a negative Lift-Off, Empty Can, and Drop Arm Test. She had positive stability testing with the Shoulder Apprehension Test. She had a negative Crossover Maneuver. There was mildly positive impingement testing with the Hawkins test. She had a negative Neer's test. There was painless weakness with O'Brien's test.
Strength: 5/5 in forward flexion, abduction, adduction, external rotation, and internal rotation.
Her sensation was grossly intact to light touch in bilateral upper extremities.
Vascular: radial pulses were +2 in bilateral upper extremities.

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