Shoulder Pain-Basketball

Abstract

HISTORY: 16 year-old male multi-sport athlete developed left shoulder and anterior chest pain while weight lifting in the off season. Initial shoulder and pectoralis evaluation was unremarkable. He initiated PT with limited improvement and subsequently discontinued his participation in sports. His pain was suggested to be chronic and exacerbated with running, sneezing and movement of neck and shoulders. Due to ongoing symptoms and lack of diagnosis, a second opinion was sought at our institution. PHYSICAL EXAMINATION: Well appearing with age appropriate development. No significant atrophy, swelling or deformity of the left shoulder or spine. Midline tenderness to palpation T1-T3. No tenderness to palpation of the anterior chest wall. Limited neck flexion, otherwise neck and left shoulder ROM were full and pain free. Bilateral upper extremities had full and symmetric muscle strength and physiologic reflexes. Minimal pain with left empty can/full can provocative testing. DIFFERENTIAL DIAGNOSIS: Rotator cuff tendinopathy, Pectoralis strain, Brachial Plexopathy, Mechanical back pain, Neoplasm TESTS AND RESULTS: MRI chest: lobulated enhancing mass T2 vertebral body with soft tissue infiltration of the left T1-3 neuroforamen and involvement of the epidural space with mass effect on the spinal cord. CT guided biopsy: bone forming neoplasm FINAL WORKING DIAGNOSIS: Aggressive Osteoblastoma TREATMENT AND OUTCOMES: Shoulder pain was referred from central neoplastic process and pediatric oncology and orthopedic surgery consulted. Surgical resection pursued with pre-operative transarterial embolization. Stage 1: anterior T2 vertebrectomy with placement of expandable cage. Stage 2: posterior epidural tumor removal, decompression and instrumented fusion C7-T5. Final surgical pathology osteoblastoma. PM&R consulted and patient worked with PT and OT during acute hospital stay. Rapidly progressed from mod-max to min assistance for ADL/IADLs and functional mobility. Discharged post-op day 7 with home exercise program for left upper extremity incoordination. Stable 3 week post-op visit, will start formal OT upon returning home.