ARM PAIN-FOOTBALL

Abstract

840 HISTORY-A 20 year old lineman for a Division IA football team was injured in a game when he was blocking an opponent. His arm was pulled away from his body when he felt something pop in his left, non-dominant shoulder. He had immediate onset of pain but no parasthesias. He did not feel his shoulder subluxate or dislocate upon careful questioning. He had no previous problems whatsoever with that arm or shoulder. He noted immediate onset of swelling in his arm and went to the sidelines for evaluation. PHYSICAL EXAMINATION-The player was alert and oriented but was in moderate discomfort. He was neurologically intact distally with normal sensation, motion and strength in his hand and wrist. He had pain in his mid-arm with flexion and extension of his elbow but had no weakness to resisted elbow flexion. His shoulder pads were removed and he had no deformity. There was mild swelling about his proximal, medial arm. He had limited abduction to 120 degrees with pain. Muscle testing of his deltoid, supraspinatus, infraspinatus and triceps was normal. He had a palpable pectoralis tendon with resistance to the pectoralis muscle. He was tender to palpation lateral to his pectoralis insertion and along his proximal arm in this area. Due to his size it was difficult to assess whether there was a defect in his biceps region. He was removed from play, given a sling and ice was applied to his arm. DIFFERENTIAL DIAGNOSIS Fracture proximal humerus Rupture biceps tendon or coracobrachialis Pectoralis tendon rupture Occult subluxation shoulder TESTS AND RESULTS Plain radiographs of shoulder and arm: normal Magnetic resonance imaging of arm-ruptured long head of the biceps tendon. FINAL/WORKING DIAGNOSIS: Rupture long head of biceps tendon TREATMENT Symptomatic treatment with ice, NSAID's and range of motion exercises Surgical tenodesis of long head of biceps tendon one week later Immobilization with sling two weeks with no shoulder motion Rehabilitation progressing from range of motion to isometrics to light weights Gradual return to activities and sports