Chronic Axillary Pain and Weakness in a Recreational Weight Lifter

Abstract

HISTORY: A 19 year old college student and recreational weight lifter presents with chronic right axillary pain and mass. His pain started 8 months earlier while doing a human flag pole pose (holding onto a pole and lifting his body parallel to the ground). He felt an acute onset of sharp pain over right axillary region. He self treated with ice and foam roller without any improvement. He saw his primary care doctor who prescribed physical therapy. He attended 10 sessions with no improvement. Pain is currently 5/10, aching, worse after lifting weights and with palpation of the mass. PHYSICAL EXAMINATION: Exam reveals no ecchymosis on inspection. There is a 2x2 non-mobile soft tissue mass over posterior inferior axillary region that is tender to palpation. Shoulder abduction and flexion on right is limited to 160 degrees with full internal/external rotation. 4+/5 strength with shoulder adduction. DIFFERENTIAL DIAGNOSIS: Infraspinatus tear, teres major tear, latissimus dorsi tear, lipoma, liposarcoma, neurofibroma, hematoma, asymmetric fat deposition, rhabdomyosarcoma TEST AND RESULTS: US of right latissimus dorsi: Imaging shows a heterogenous hypo and hyperechoic circular array within the right latissimus dorsi muscle measuring 2cm x3cm. FINAL WORKING DIAGNOSIS: chronic latissimus dorsi tear. TREATMENT AND OUTCOMES: Due to chronicity of symptoms and failure of physical therapy, patient elected for dextrose tenotomy. At one month follow up, he reported improvement in his pain from 5/10 to a 2/10, and was advised to slowly increase his activity. Three months after initial treatment, returned for follow up and reported 80% improvement in symptoms and strength. He elected for repeat dextrose tenotomy, and after the procedure was referred to physical therapy. After one month of physical therapy, he was discharged with full strength and complete resolution of pain. He was able to successfully audition for America Ninja Warrior.