Shoulder Injury-football

Abstract

HISTORY: A college football tailback with a known Bankart lesion sustained a shoulder injury after being tackled. During a game he received a posterolateral blow to the left shoulder by a helmet from an opposing player. He described immediate generalized left shoulder pain with transient numbness and tingling in the upper arm which resolved spontaneously. He reported weakness to abduction, forward flexion and elbow flexion associated with significant pain during these movements. He did not return to the game. PHYSICAL EXAM: Examination on the sidelines revealed no gross bony deformity or immediate swelling. There was diffuse tenderness to palpation over the anterior and superior aspect of the shoulder. His active range of motion was significantly reduced in forward flexion, abduction and external rotation of the shoulder. He also had weakness with resisted shoulder abduction, forward flexion, and external rotation, as well as with elbow flexion. There was decreased sensation to light touch over the shoulder and upper arm as compared to the right. Instability and apprehension signs were difficult to assess secondary to significant pain and inability to abduct and externally rotate the shoulder. The weakness and decreased sensation resolved spontaneously within 30 minutes. DIFFERENTIAL DIAGNOSIS: Anterior shoulder subluxation Distal clavicle fracture Scapular fracture Acromioclavicular joint sprain Contusion TEST AND RESULTS: Plain films (obtained the next morning): 3 views of the left shoulder -Fracture of the glenoid fossa extending into the neck of the glenoid and into the body of the scapula CT with 3 dimensional reconstructions (2 days after injury): -Mildly comminuted minimally displaced fracture of the scapula including the base of the glenoid and the glenoid fossa. FINAL DIAGNOSIS: Comminuted minimally displaced fracture of the glenoid and body of the scapula TREATMENT/OUTCOMES: 1. Immediate treatment consisted of placement in a sling and oral pain medications. Surgery was scheduled on the third day after the injury for internal fixation and repair of the old Bankart lesion. Return to play guidelines will follow recovery from surgery and will be driven more by Bankart repair than by internal fixation of the fracture.