Shoulder Pain - Bullriding

Abstract

HISTORY: A 22-year-old right-hand dominant female bullrider sustained a right shoulder injury following a bullriding accident. She fell off a bull while bullriding and landed on her right flexed elbow. She had immediate pain and swelling in the right shoulder. She went to the ER where radiographs revealed a displaced proximal humerus fracture. She underwent open reduction and internal fixation the next day at an outside hospital. She returned home and presented to our clinic two weeks later for follow up with increasing pain and and stiffness. She was advised to decrease her use of the arm, to do only gentle ROM and to avoid weight bearing on the arm. She was followed every 6 weeks with radiographs but continued to have pain and loss of motion. PHYSICAL EXAMINATION: There was no atrophy or winging bilaterally. There were no signs of infection or deep venous thrombosis. She was entirely neurologically intact including motor and sensation for all nerves in her right extremity. The vascular examination was normal in both extremities. She had limited abduction, forward flexion, and internal and external rotation on her affected side . She had full range of motion in her elbow, wrist, and fingers. DIFFERENTIAL DIAGNOSIS: Delayed union of fracture Nonunion of fracture Infection at fracture site Complex regional pain syndrome Rotator cuff dysfunction TESTS AND RESULTS: Plain AP and axillary radiographs of the shoulder at 3 months post-op: nonunion of fracture of right humerus status post plate fixation CT of the shoulder at 3 months post-op: confirmed the findings on the plain radiograph FINAL/WORKING DIAGNOSIS: Nonunion of right proximal humerus fracture status post ORIF TREATMENT AND OUTCOMES: Bone stimulator used for 6 weeks, however patient continued to have pain and persistent gap Revision of right proximal humerus nonunion with ORIF and right tibial autograft Non-weight bearing with right upper extremity and arm in a sling. Allowed passive and active ROM of shoulder, elbow, wrist, and fingers. At 2 weeks post-op, weightbearing progressed up to 5 lb and physical therapy started with ROM without limits. Radiographs at 3 months post-op showed healed fracture. Patient advised to avoid trauma. She has been since returned to bull riding with no symptoms.