Acute Pain and Dysfunction of Shoulder Musculature - Football Strong Safety

Abstract

HISTORY: A 22-year old collegiate football strong safety presented with acute posterior right shoulder pain that increased with shoulder flexion and abduction. The patient injured himself diving to catch a ball in practice and reported a “dead arm” feeling after hitting the ground. He rated his pain 6 out of 10 on the Numeric Rating Scale (NRS) and denied change in symptoms for the next two days following onset. The patient had been treated with rest and ice. The patient had a previous history of bilateral labral pathology, but reported being otherwise healthy. PHYSICAL EXAMINATION: Examination 3 days post-injury revealed palpable tender points (TP) at the posterior shoulder. The patient exhibited decreased active flexion (135°) and abduction (130°) on the affected side and reported pain rated 3 out of 10 on the NRS during active horizontal adduction, flexion and abduction. Manual muscle testing indicated a 4 out of 5 strength for the supraspinatus, infraspinatus, and teres major musculature. Orthopedic special tests were negative for labral pathology, shoulder impingement, and shoulder laxity. The neurological examination was unremarkable. DIFFERENTIAL DIAGNOSIS: 1. Rotator Cuff Strain 2. Glenoid Labrum Tear 3. Brachial Plexus Neurapraxia TESTS and RESULTS: Not Applicable FINAL/WORKING DIAGNOSIS: Rotator Cuff Inhibition TREATMENT AND OUTCOMES: 1. Initially, patient treated with active arm motions (i.e., shoulder flexion, shoulder abduction, and single-arm wall push-up) on the “good” side (i.e., uninvolved side) using static holds at end range or repetitions. Post treatment measures indicated improvements of 37° in flexion and 45° in abduction on the involved side, and a two point decrease in pain on the NRS. 2. Patient maintained improvements from first treatment at subsequent visit. Cervical and thoracic spine were rechecked and cleared. Posterior shoulder TPs were still present and were treated by maintaining a position of comfort for 60 seconds. Patient reported a resolution of pain with all shoulder motion following this treatment. Dynamic neuromuscular stabilization with perturbations was then performed in a PNF D2 shoulder pattern to reestablish neuromuscular control. 3. After two follow-up treatments the patient was discharged and remained asymptomatic at one month follow-up.