SHOULDER INJURY - FOOTBALL

Abstract

HISTORY A 19-year-old college football defensive cornerback injured his left shoulder in spring football. He states that while breaking up a pass, the receiver tripped, and the patient fell onto his left side and felt a strong popping sensation with severe pain in his left shoulder. As a result of this injury he was unable to play for the remainder of the spring practice and beyond. Because of continuing night pain and disability, an MRI was performed by his initial orthopedist. Soon after, he was referred to our clinic for a second opinion. PHYSICAL EXAMINATION The patient is a well-developed, well-nourished male in no acute distress. Examination is notable for the left shoulder, which demonstrates tenderness over the anterior cuff area, with no edema present, no neurovascular compromise, and no atrophy. ROM testing demonstrates elevation to 170° with achievements slowly, abduction to 150°, internal rotation equal to the opposite side and the level of approximately T6, with pain at all extremes of motion. DIFFERENTIAL DIAGNOSIS Bursitis/tendonitis. Shoulder strain. Clavicle fracture. AC tear/sprain. Shoulder subluxation. Rotator cuff tear. TESTS AND RESULTS Right shoulder anterior-posterior, lateral, and trans-thoracic radiographs – negative for fracture and dislocation – grossly negative for other abnormalities MRI of the right shoulder – positive for a large rotator cuff tear. FINAL/WORKING DIAGNOSIS Right rotator cuff tear in a collision sport athlete. TREATMENT AND OUTCOMES Rotator cuff repair surgery. At 13 weeks post-operatively, his ROM showed active elevation to 125° with scapular rotation, abduction to 95°, internal rotation to the level of T6, which is equal to his opposite side. PROM was found to be completely full without muscle spasm or tenderness. He had no complaints of pain at rest. He is currently scheduled for continuing follow-up.