SHOULDER INJURY - FOOTBALL

Abstract

302 HISTORY - A 19-year-old elite college football defensive lineman sustained a shoulder injury while tackling another player during a practice scrimmage. During the tackle another player fell on the back of his abducted left shoulder. He noted immediate pain and weakness in his shoulder. He denied paresthesias. He reported his symptoms to the athletic trainers and was taken out of the game. PHYSICAL EXAMINATION - Initial examination on the sidelines revealed no deformity of the shoulder. There was moderate tenderness in the posterior aspect of the left shoulder overlying the infraspinatus and trapezius muscles. Range of motion was limited in elevation and rotation secondary to pain. He was able to fire all muscle groups, but had weak deltoid, supraspinatus and external rotators. He denied any neck tenderness and he had normal sensation in the extremity. The affected arm was placed in an arm sling on the sidelines and ice was applied. His shoulder was re-examined after icing. There was still significant tenderness to palpation and pain with any attempted motion of the left shoulder. The pain progressively worsened and required narcotic analgesics. DIFFERENTIAL DIAGNOSIS: Anterior left shoulder dislocation Traumatic rotator cuff injury Scapular fracture Brachial plexus neuropraxia “stinger” TESTS AND RESULTS: RADIOGRAPHS: Left shoulder AP, True AP, and axillary: humeral head located normally on the glenoid an area of lucency at the neck of the scapula, that appears consistent with a vascular groove CT SCAN Left shoulder without contrast: (axial and coronal reconstruction in 5 mm increments) -Non-displaced vertical extra-articular fracture through the glenoid base of the left shoulder FINAL/WORKING DIAGNOSIS: Non-displaced left scapular glenoid base fracture TREATMENT: Immobilization in a shoulder immobilizer for 2 weeks Pendulum exercises and range of motion exercises 2 weeks after the injury. Rotator cuff and deltoid strengthening exercises for 3 and 4 weeks post injury. Cardiovascular workouts continued throughout rehabilitation Phased back to contact once near full strength achieved at 2 months post injury.