Shoulder Injury - Soccer, Water Polo

Abstract

HX: 3 Division I athletes at 1 university. Case 1- 21F soccer center midfielder presented with 1 month of insidious L shoulder pain that started posteriorly at the rhomboids and slowly migrated anteriorly. She denied any trauma. All activity worsened the pain, particularly shoulder ROM. She completed 6 weeks of rest and PT without improvement. Case 2- 19M water polo player presented with 2 months of R posterior shoulder pain without preceding trauma. He improved with 2 weeks of light activity and PT, but the pain worsened as he increased activity and acutely worsened after contact play. Case 3- 19M water polo player presented with 2 weeks of insidious onset L posterior shoulder pain. While executing power cleans, the pain became severe and he went to the ED. EXAM: Case 1-Diffuse pain limited L shoulder ROM. +mild GH internal rotation deficit. +tenderness and spasm of L trapezius, neck, levator, posterior deltoid, rhomboids. Spurling’s (-). RTC testing nl except for pain with supraspinatus testing. O’Brien’s (-). Case 2-Nl visual inspection. The R shoulder had full ROM with mild discomfort posteriorly with full abduction. R rhomboid major tender to palpation. RTC testing nl; O’Brien’s (-). Case 3-Nl inspection, ROM. L rhomboid major tender to palpation. RTC testing nl, biceps testing (-). DDX:1. Rhomboid strain 2. Myofascial pain 3. Suprascapular nerve impingement 4. Thoracic outlet syndrome TESTS/RESULTS: Case 1- L shoulder XR- nondisplaced stress fracture L 1st rib Bedside U/S- cortical irregularity of 1st rib CT chest w/o contrast- stress fracture L 1st rib Case 2- R shoulder XR,R ribs XR,MR RUE w/o contrast- nl Bedside U/S- cortical irregularity of R 1st rib Retrospective review of original XRs revealed subtle cortical irregularity of R 1st rib CT chest w/o contrast- nondisplaced stress fracture R 1st rib Case 3- CXR,L shoulder XR,CT chest w/o contrast- nondisplaced fracture L 1st rib Bedside U/S- L 1st rib fracture with large callus formation FINAL DX:1st rib stress fracture TX/OUTCOME: All cases with 1st rib stress fracture healed with standard relative rest, calcium and Vitamin D supplementation.