Shoulder Pain in a Professional Contemporary Ballet Dancer

Abstract

HISTORY: A 22 year-old male professional ballet dancer presented with a 1 year history of non-radiating, posterior right shoulder pain. The pain severity was between a 0-8/10, and was aggravated when lifting other dancers. He denied any instability, clicking or catching, weakness, or numbness or tingling. One year ago, while dancing, he fell on his right shoulder/neck. By report, a c-spine MRI revealed a cervical disc herniation (unknown level). He was treated successfully with physical therapy, but his pain gradually recurred. PHYSICAL EXAMINATION: Fit appearing 22 year-old male in no distress. At rest, the right shoulder was elevated and protracted. There was subtle scapular dyskinesis with a delay in right scapular movement and prominent right medial scapular border. He was tender over the supraspinatus and infraspinatus muscles. Cervical and shoulder motion were full and symmetric. Special tests revealed a (-) Spurling’s, and mild peri-scapular pain with position one of O’Brien’s, empty can and Hawkin’s impingement tests. Neurovascular exam was normal. DIFFERENTIAL DIAGNOSIS: Rotator cuff tendinopathy/tear Labral tear Scapular dyskinesia Peri-scapular myofascial pain Subacromial bursitis Cervical radiculopathy Glenohumeral instability TESTS AND RESULTS: Complete diagnostic shoulder ultrasound revealed supraspinatus, infraspinatus, and teres minor hyperechogenicity and loss of the normal muscular architecture with atrophy, consistent with fibrofatty infiltration from his prior C5 or C6 radiculopathy. Subacromial bursa was hypertrophic, consistent with subacromial bursopathy. FINAL/WORKING DIAGNOSIS: Scapular dyskinesis, likely secondary to right C5 or C6 chronic radiculopathy with denervation changes to the supraspinatus, infraspinatus, and teres minor. Subacromial bursopathy TREATMENT AND OUTCOME: The patient was given a rehabilitation program for scapular stabilizers, rotator cuff, postural positioning, stretching anterior shoulders, and trial of Kinesio tape. The patient returned to ballet, was advised to use caution with lifts. He was given the option of returning in 4-8 weeks for an ultrasound guided subacromial corticosteroid injection if there was no improvement with rehabilitation.