Shoulder Pain After Surfing

Abstract

HISTORY: A 16 year old male was referred to our clinic by his orthopaedist for evaluation and management of pain in his right, dominant shoulder. He had no previous problems with his shoulder until 2 months prior to presentation, when he suffered a forceful blow to his shoulder against the sand while surfing. His pain slightly improved after 3 days of ibuprofen, ice, and rest, but worsened when he returned to competitive swimming. The patient did not have any neck pain or parasthesias. He was initially diagnosed with an anterior shoulder dislocation, but the pain persisted, and MRI examination was performed. This was interpreted as having a Hill-Sachs lesion and he was given a diagnosis of shoulder instability. He was referred to our clinic on the suspicion of continued shoulder instability and for consideration of surgical intervention. EXAMINATION: The patient was in no acute distress with no atrophy or deformity. He had no scapular dykinesis or winging. He had full range of motion except for the loss of 2 spinal levels of internal rotation up the back. His sensory exam was normal to light touch including his axillary nerve distribution. Manual muscle testing was unremarkable except for mild shoulder pain with resisted external rotation and resisted abduction. He had a positive Neer impingement sign and positive Hawkins sign. He had negative posterior and anterior apprehension signs, and was too painful for laxity testing. He was tender over his anterolateral proximal humerus on the greater tuberosity area. DIFFERENTIAL DIAGNOSIS: Anterior shoulder instability Rotator cuff tear Superior labrum anterior posterior lesion (SLAP) Fracture of humerus or glenoid TESTS AND RESULTS Plain shoulder radiograph: minimally displaced greater tuberosity fracture MRI: minimally displaced greater tuberosity fracture; no Hill-Sachs lesion, rotator cuff tear or labral lesion. FINAL/WORKING DIAGNOSIS: Minimally displaced greater tuberosity fracture TREATMENT AND OUTCOMES Activity modifications: cross training if no pain NSAIDs as needed Follow up in 6 weeks time a. X-rays: healing of fracture b. Returned to sports/activities with no pain 4 months after injury