Shoulder Injury - Football

Abstract

HISTORY: A 14-year-old freshman high school football player sustained a left shoulder injury after landing directly on his left shoulder while attempting to catch a pass. The receivers and quarterbacks had been practicing receiving routes without pads. The patient dove in order to catch an overthrown pass. He landed on the lateral aspect of his left shoulder. The patient heard a pop when he landed and experienced immediate pain in his shoulder, which he rated as a nine out of ten. There was no swelling, numbness, tingling, or radiating pain. Ice was applied to the shoulder immediately. The patient was seen 2 days later in the sports medicine clinic. PHYSICAL EXAMINATION: Examination in clinic revealed tenderness of the entire left shoulder with significant pain to palpation of the posterior aspect of his acromion and his coracoid process. No obvious deformities noted on inspection. Limited range of motion of the shoulder due to pain. Positive arm cross over test. DIFFERENTIAL DIAGNOSIS: Shoulder subluxation AC joint sprain Occult fracture Salter-harris fracture of Coracoid Shoulder contusion TEST AND RESULTS: AP internal/external rotation and axillary radiographs of the left shoulder -Slight widening of the coracoid synchondrosis on the left, previous left shoulder x-rays demonstrated a normal shoulder with closed coracoid apophysis. -Alignment of the acromialclavicular joint is normal -The humeral head is congruent with the glenoid MRI left shoulder: -Nondisplaced acute fracture through the base of the coracoid process with diffuse surrounding bone marrow edema -No evidence of rotator cuff, biceps tendon, or glenoid labrum tear. FINAL WORKING DIAGNOSIS: Non-displaced fracture through the base of the left caracoid process TREATMENT AND OUTCOMES: Vicodin for pain control initially and transitioned to motrin Immobilized in a sling for two weeks then permitted to wear sling as needed Physical activity limited to non contact activities with no risk of fall Physicial therapy of the shoulder initiated 3 weeks status post injury