Rare Shoulder Injury In A 12-year Old Male Football Player.

Abstract

HISTORY: A 12-year-old junior league football player sustained left shoulder injury after a 1 on 1 hit during practice drills 9 days prior to presentation. He reports the other player's helmet was driven into his anterior left shoulder, where he suffered immediate 7/10 shoulder pain. He presented to an emergency department where x-rays were apparently suspicious for potential AC joint separation. His treatment includes the use a sling, and occasional ibuprofen for pain relief. His pain at evaluation was 3/10, aggravated by any shoulder ranges of motion, and associated with stiffness. He denies bruising to the shoulder. He denies any numbness, tingling, or weakness. His past medical history is significant for seasonal allergies and chronic otitis media with tympanostomy tube placement. He is also is taking clarinex and nasonex. PHYSICAL EXAMINATION: Alert adolescent male in no apparent distress. There is no deformity, bruising, or ecchymosis. He is tender over the coracoid process and proximal humerus. He has full passive range of motion. He has pain with active abduction greater than 20 degrees and strength is 4/5 with abduction secondary to pain. Strength is 5/5 in internal and external rotation. Speed's test is unable to be performed secondary to pain. Kennedy Hawkins test is equivocal. Crossover-adduction test is equivocal. Obrien's test is equivocal. Apprehension-relocation test is equivocal. DIFFERENTIAL DIAGNOSIS: Occult fracture Salter-Harris fracture of the proximal humerus Salter-Harris fracture of the coracoid Shoulder contusion AC joint sprain Shoulder subluxation TESTS AND RESULTS: Left shoulder from ED visit: Frontal, Y, and axillary views showed no AC separation, fracture, or soft tissue swelling and showed no difference with right shoulder views taken. MRI demonstrates Salter-Harris I fracture of the coracoid process with increased T2 signal along the coracoid physis. FINAL WORKING DIAGNOSIS: Salter-Harris I fracture of the coracoid. Treatment and Outcomes: Immobilization with sling for 4 weeks Resolution of coracoid tenderness at 3-4 weeks Physical therapy initiated 5 weeks after injury with excellent results Return to sports planned at next football season after discussion with parents