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Swinging For The Fences: An Unusual Case Of Back Pain - Page #1
 

Author: Arvind Balaji, MD
Co Author #1: Dr. Randon Hall MD
Senior Editor: Mandeep Ghuman, MD, FAMSSM
Editor: Brian Kim, MD, MS

Patient Presentation:
A 14-year-old adolescent male baseball player presented to sports medicine clinic with two and a half weeks of mid-upper back pain.

History:
The patient reported experiencing acute pain between his shoulder blades after overexerting himself on a swing during batting practice. He described it as a sharp pain, worse with twisting, sneezing, neck flexion, coughing, and stretching. He had already tried six sessions of physical therapy, which included some dry needling, but did not find it helpful. Non-steroidal anti-inflammatory drugs also did not provide significant relief. He was initially diagnosed with a thoracic musculoskeletal strain and was prescribed a steroid pack and instructed to continue physical therapy. He returned 1 month later with persistent symptoms.

Physical Exam:
On exam, shoulders were at equal height. He had full range of motion of both shoulders and his neck. His forward bend test showed slight right thoracic prominence. There was pain reproduced with palpation over the paraspinal muscles of the upper thoracic area on the right side, primarily over the rhomboid. There was also vague point tenderness within the right supraclavicular fossa. He had no pain or weakness with internal and external rotation of the right shoulder. He had mild weakness with empty can test on the right, mainly due to pain. He also reported pain with cross body adduction of the right shoulder. Spurling maneuver was negative bilaterally.

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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