Author: Scott Schmuki, MD
Co Author #1: Austin Taylor MD
Co Author #2: Michael McCoy MD
Senior Editor: Justin Mark Young, MD
Editor: Julia Rawlings, MD

Patient Presentation:
The patient presented to the orthopedic clinic with a one day history of left shoulder pain.

History:
A 14-year-old male athlete presented to the clinic with a 1-day history of left shoulder pain. The day prior to presentation he was tackled to the ground with only minor turf burns. Later he woke up with significant shoulder pain and was unable to go back to sleep. Also, he reported very limited range of motion of the shoulder. He has been using ibuprofen for pain relief. Initial shoulder x-rays showed no acute fractures and growth plates were open with no evidence of displacement Case Photo #1 . The recommendation was to move forward with conservative treatment with NSAIDs and sling immobilization with early range of motion exercises.


Over the next few days his pain did not improve and his range of motion was worsening. MRI was ordered and performed within a few days. The MRI showed a very large joint effusion, bone contusion on the superior humeral head and partial rotator cuff tear Case Photo #2 and Case Photo #3 . He returned the day after his MRI, and his exam was overall unchanged. The patient did report a fever of 101.7 F over the weekend and complained of some upper respiratory infection symptoms. On the day of his visit, his cold symptoms had improved. The decision was made to perform a joint aspiration of his effusion for pain relief. When aspirating his shoulder, they drained about 30-40 cc of thick purulent fluid.

Physical Exam:
General: No acute distress.
Respiratory: No respiratory distress.
CVS: Pulses normal
Musculoskeletal: Some abrasions over the left elbow. No overlying skin changes to the shoulder. Difficulty with active forward elevation, passive to 90 degrees with discomfort. Pain with resisted deltoid testing. No tenderness over the clavicle or AC joint, but tenderness over anterolateral edge of acromion with less tenderness over proximal humerus. Neurovascularly intact in distal extremity.

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