An Unusual Case Of Shoulder Pain In A High School Football Player

Abstract

HISTORY: A 15 year-old right hand dominant male presented to sports medicine clinic due to left shoulder pain. The mechanism of injury was while playing football the day prior where he jumped to catch a pass, and landed directly on grass onto his left shoulder with arm by his side. Heard a “pop” when he landed, and was experiencing intermittent, generalized shoulder pain since the event. Denied prior injury of affected extremity as well as denied numbness or tingling. There was no swelling, discoloration, or bruising per the patient or the mother of the patient. There was no obvious reported deformity of the shoulder as well. The patient denied any neck or elbow pain. Symptoms were improved at rest and with arm at his side. PHYSICAL EXAM: Left Shoulder: Pain with passive abduction, flexion on range of motion (ROM) testing. Active ROM is full in all directions. Tender to palpation (TTP) at the AC joint and scapular angle; no TTP at scapular body. Strength: 2/5 supraspinatus, 3/5 external rotation, 4/5 internal rotation, abduction, and biceps. Positive empty can and drop arm. No erythema, normal sensation throughout left upper extremity, and radial and ulnar pulses 2+ and regular. DIFFERENTIAL DIAGNOSIS: 1. Acromioclavicular sprain 2. Rotator Cuff injury 3. Glenoid labrum injury 4. Distal clavicle contusion 5. Glenohumeral dislocation TEST AND RESULTS: 1. XR Left Shoulder: no acute fracture, dislocation, or soft tissue abnormality2. XR Left Scapula: No acute displaced fracture. 3. MRI (no IV contrast) Left Shoulder: Feathery edema in the rotator cuff musculature centered about the scapula. Low grade muscular strain vs underlying non-displaced scapular body fracture. 4. CT Shoulder Trauma w/ Joint (no IV contrast): Non-displaced hairline fracture in the mid scapular body perpendicular to the long axis. AC and GH joints are intact. FINAL WORKING DIAGNOSIS: Non-displaced extra-articular fracture in the mid scapular body TREATMENT AND OUTCOMES: 1. Immobilization with sling for initial 4 weeks with pendulum swings twice daily 2. At week 4, no pain at rest with asymptomatic full strength. Physical Therapy initiated. 3. Cleared for non-contact and non-collision activities at week 8. 4. Returned to all activities without restriction at week 12.