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The Dislocation Confabulation - Page #1
 

Author: Emily Lenherr, MD
Senior Editor: Kristine Karlson, MD, FAMSSM
Editor: Charles Litchfield, MD

Patient Presentation:
A fifteen year old male wrestler presented to the family medicine clinic with left shoulder pain. He reported he was at a wrestling tournament two and a half weeks prior when he believed he dislocated his left shoulder. He felt a pop and immediate pain after an initial takedown. He came out of the match unable to move his arm and his athletic trainer attempted a reduction. He felt much better and returned to wrestling.
During his following match, his arm was twisted behind his back and felt another pop. A medical timeout was called and his athletic trainer attempted another reduction after which he attempted to return but failed secondary to pain and was pulled from the meet. He presented for an evaluation due to severe pain with increasingly limited shoulder motion.

History:
No pertinent past medical history.

Physical Exam:
On examination, he denied any numbness or tingling of his hand. He had been in a sling since the injury date. The left shoulder had a normal appearance with no bruising, swelling, or skin changes. No tenderness to palpation over the clavicle, AC joint, or SC joint. There was tenderness to palpation over the lateral and anterior shoulder. His ROM was limited to active and passive forward flexion to 30 degrees, abduction to 60 degrees, internal rotation to iliac crest, and external rotation to 20 degrees. Strength was four out of five globally secondary to pain. Normal sensation throughout the shoulder, forearm, and hand. Special testing including Hawkins, Neer's, O'Brien's, and empty can were limited secondary to pain.

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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