Shoulder Injury - Weightlifting

Abstract

HISTORY 26 y/o male amateur weightlifter presented to ER with b/l shoulder dislocations. He performed seated military press with 95 lbs. He experienced immediate pain in b/l shoulders and a clunking sensation. In ER, bilateral anterior shoulder dislocations reduced under conscious sedation. He had decreased sensation over the lateral right deltoid, and unable to abduct his right arm above shoulder. No neck pain or prior shoulder trauma. PHYSICAL EXAMINATION Atrophy of right deltoid and supraspinatus. PROM left shoulder: 150° abduction, 150° forward flexion, 25° external rotation. AROM left shoulder: 100° abduction, 100° forward flexion. PROM right shoulder: 80° abduction, 90° forward flexion, 20° external rotation. AROM right shoulder: 70° abduction, 90° forward flexion, 20° external rotation. MMT left upper extremity: 5/5 throughout. MMT right upper extremity normal except: shoulder abduction 3±/5, external rotation 4/5. Sensation in left upper extremity normal to pinprick. Sensation to pinprick reduced over right deltoid in an axillary nerve distribution. DIFFERENTIAL DIAGNOSIS b/l anterior shoulder dislocation Right C5 radiculopathy Right rotator cuff tear Right axillary nerve neuropathy Right suprascapular neuropathy Right frozen shoulder Right labral tear TEST AND RESULTS MRI Right shoulder 2 mos post injury: Partial tear distal supraspinatus. AC joint normal. Hill-Sachs lesion posterior lateral humeral head, subchondral edema. No labral tear. EMG/NCS - b/l upper extremities 10 weeks post injury: Rt Axillary CMAP: No response. Lt Axillary CMAP: Latency − 3.9ms, amplitude 10mV. EMG: R Deltoid-2± fibs, 2± psw, many polyphasics, reduced interference pattern, R Teres Minor-1± fibs, few polyphasics, R biceps brachii, triceps and infraspinatus-normal FINAL WORKING DIAGNOSIS b/l anterior shoulder dislocations Right Axillary mononeuropathy with early reinnervation. Small right supraspinatous tear Right Hill-Sachs lesion TREATMENT AND OUTCOMES 8 days post injury: PT focused on ROM with HEP. 1 mo post injury: at work with light duty and computer work, right shoulder stiff and weak 3 mos post injury: light strengthening in conjunction with HEP to strengthen right shoulder 6 mos post injury: difficulty with ADL's. PT program with modalities prn and soft tissue mobilization. Continued ROM and strengthening for shoulder. 7 mos post injury: pain free, mild stiffness in right shoulder. No weightlifting but returned to biking. ROM full. Strength 5/5 with right shoulder abduction, forward flexion. External rotation of 5−/5. Left shoulder full strength. Returned to previous work duties.