SHOULDER PAIN - TENNIS

Abstract

HISTORY A 12-year-old male competitive tennis player, presented with gradual onset of right shoulder pain for several weeks, but worsened within the past week. Pain is present only during his forehand tennis swing, and denies pain during his overhead or backhand swings. No pain at rest. No direct blow to the right shoulder. No “pop” or feeling a “tear”. Pain is localized to the anterior aspect of the right shoulder. No numbness, weakness or parastesias. The patient has maintained full range of motion at the right shoulder. PHYSICAL EXAMINATION Asymmetry of the shoulders is apparent when comparing the crease at the antecubital fossa. The crease at the right antecubital fossa is more than one inch lower in comparison to the left. The patient has full range of motion at the right shoulder. Pain is present only with forced adduction beyond 90 degrees of flexion. The clavicle appears grossly intact with no tenderness on palpation of the clavicle, acromioclavicular/sternoclavicular joint and coracoid process. Negative acromioclavicular/sternoclavicular compression test. No tenderness on palpation of the bicipital groove. Normal internal rotation reach test. There is 5/5 strength in all muscle groups and symmetric with the left shoulder. Speed test negative. Kibler's test positive. Lateral slide and winging noted on the right with a normal appearing scapula on the left. The long thoracic nerve appears intact during “wall push-up” test. Normal glenohumeral stability. Negative sulcus and apprehension tests. Negative impingement testing. The spine appears straight, during flexion there is no rib hump, spinal curvature, or kyphosis noted. The patient does have fairly good truncal support, and is capable of standing on one foot and squat with only moderate difficulty. DIFFERENTIAL DIAGNOSIS Tennis shoulder. Rotator cuff tendonitis. Rotator cuff tear. Biceps tendinitis/Subluxation. Impingement syndrome. Fracture of proximal humeral physis. Glenohumeral instability. Referred pain. TEST AND RESULTS Shoulder radiographs: Normal FINAL/WORKING DIAGNOSIS Right Scapulothoracic dyskinesis. TREATMENT AND OUTCOMES Tennis specific conditioning program, including rehabilitation focusing on the internal rotation to external rotation ratios. Analyze and correct technique. Continue tennis, using level of discomfort as a gauge for level of exertion.