Shoulder Injury - Bicycling

Abstract

HISTORY: A 13-year-old female sustained an injury to her left shoulder in a fall from her bicycle 6 days prior. Patient was seen initially in the emergency department where an anterior shoulder dislocation was diagnosed with additional finding of a small anterior fracture of her humeral head on x-ray. Closed reduction was performed under conscious sedation in the emergency department. She was placed in a sling and swathe with her arm in internal rotation. Patient presented with her father in the Sports Medicine Center to discuss further management and potential treatment options. PHYSICAL EXAMINATION: General - healthy appearing female in no acute distress. Neurovascular status is intact. Range of motion testing reveals abduction of left shoulder to 90 degrees, forward flexion to 80 degrees, and extension of 10 degrees. Pain is present with attempted external rotation. Patient in general is apprehensive to exam. DIFFERENTIAL DIAGNOSIS: Anterior shoulder dislocation with humeral head fracture with or without disruption of capsular labral complex. TESTS AND RESULTS X-rays reveal relocated humeral head, open growth plates. CT scan reveals fracture from the anterior surface of the epiphysis of the humeral head. Separated portion is comminuted. MRI demonstrates no evidence of a labral tear; MRI is positive for edema within inferior aspect of the subscapularis and infraspinatus muscles compatible with partial tear; and contusion and avulsion fracture at the greater tuberosity of the humeral head. FINAL DIAGNOSIS Primary anterior dislocation of left shoulder without Bankart lesion in a skeletally immature 13-year-old female. TREATMENT AND OUTCOME Discussion of risk for recurrent anterior dislocation and functional outcomes with operative versus non-operative intervention. Placed in external rotation brace for 4 weeks. Progressive increase in range of motion and strengthening with physical therapy. Fracture site with good approximation and doing well at 4 week follow-up.