Right Arm Pain—Football

Abstract

HISTORY: A 16-year-old right-hand dominant male football lineman presents for acute on chronic R anterior shoulder pain. 7 days prior to presentation he hit a blocking dummy and felt his R shoulder “pop in and out” and subsequently had a “dead arm”. Today his R shoulder feels stiff and aches with overhead activities. He has rested since the injury. No neck pain or numbness/tingling. He previously had episodes of feeling his shoulder shift out of place, none of which required formal reduction. PHYSICAL EXAMINATION: Musculoskeletal: R shoulder.Inspection: R biceps appears smaller than L; no deformity. Palpation: nonspecific tenderness over anterior shoulder. ROM: full FLEX/EXT/ABD/ER/IR; slight pain with ER and ABD. Strength: 5-/5 biceps; 5-/5 shoulder FLEX; all rotator cuff muscles are strong. Special Tests: O’Brien’s test +; apprehension/relocation test +; posterior load and shift causes pain. Neurovascular: sensation intact in all UE dermatomes; radial artery pulses 2+. Neck exam: no midline tenderness; full ROM. DIFFERENTIAL DIAGNOSIS: glenoid labral tear; glenohumeral dislocation and subsequent instability; long head biceps tendon (LHBT) dislocation; congenital absence or anomalous origin of LHBT. TEST AND RESULTS: MR shoulder arthrogram: anterior and posterior humeral head impaction fractures consistent with recent anterior and posterior shoulder dislocation; anterior and posterior labral tears; absence of long head of biceps. Diagnostic US of the R shoulder was performed after MRI reported absent LHBT. US revealed medial dislocation of the long head of the biceps located directly lateral to the coracoid process and passing over the lesser tuberosity. The bicipital groove is shallow and without overlying tendon. FINAL WORKING DIAGNOSIS: dislocation of long head of biceps; anterior and posterior glenoid labrum tear; Hill-Sachs and reverse Hill-Sachs lesion. TREATMENT AND OUTCOMES: The patient was referred to orthopedic surgery and subsequently scheduled for R shoulder arthroscopy with labral repair/capsulorrhaphy. LHBT will be evaluated and tenotomy or tenodesis will be performed depending on operative findings. The planned surgery is scheduled for after the date of abstract submission, and final treatment and outcome will be updated.