Recurrent Anterior Shoulder Pain With Repetitive Work Activity

Abstract

HISTORY: A 35 year old right hand dominant male presented with a 12 year history of intermittent anterior right shoulder pain with associated popping. He thought his pain started after he tried to catch a door from falling in a forced adduction injury at the age of 23. He stated he felt a shifting in his shoulder multiple times per day while working at a Goodyear Tire Warehouse. He had been seen by a physician 6 years later in which he had a MRI and was told he had tendinitis. At that time, the patient was given anti-inflammatories, steroid injections, and physical therapy. He had difficulty sleeping on his right shoulder and had worsening pain with shoulder extension. He was seen in the emergency department 3 days prior to evaluation for worsening pain after he felt a pop while pulling overhead. He denied numbness, tingling, or neck pain. PHYSICAL EXAMINATION: Physical exam revealed tenderness over the bicipital groove and pain elicited with extension and flexion of the right shoulder. Speed’s and yergason’s test were positive. Hawkin’s and cross arm test were negative. He had normal range of motion. Muscle strength was 5/5 bilaterally. He was neurovascularly intact. No obvious deformity was visualized or palpated. No atrophy or swelling was appreciated. No instability or apprehension noted. DIFFERENTIAL DIAGNOSIS: 1. Rotator cuff injury 2. Labrum tear 3. Bicipital tendon subluxation 4. Mass lesion 5. Impingement syndrome 6. Bursitis 7. Cervical Radiculopathy TEST AND RESULTS: Right shoulder x-ray: 5 x 10 mm osteochondroma emanating from the bicipital groove at the level of the pectoralis major tendon. Right shoulder MRI: Mild subacromial/subdeltoid bursitis FINAL WORKING DIAGNOSIS: Osteochondroma of the bicipital groove TREATMENT AND OUTCOMES: 1. Excision of osteochondroma 2. Physical therapy