Shoulder Pain And Weakness In A Football Player

TITLE: Shoulder Pain and Weakness in a Football Player AUTHORS: Samuel CohenLee ManciniMichael Maddaleni UMass Memorial HealthUMass Chan Medical School Text: 23 yo M college football player presenting 6 days after the previous football game with complaint of right shoulder pain and weakness. Describes running with the ball, lowering his right shoulder into an opposing player and feeling immediate pain and weakness. Exited the game and did not return. Since that time reports pain, which is improving and weakness, which has not improved. He has not been able to raise his arm above his head and limited to small motions in any direction. Has tried some tylenol and ice with mild temporary improvement in pain. No paresthesias, temperature change, or prior significant injury to this shoulder. No gross deformityActive abduction to 30 degActive flexion to 30 degNo pain at sternoclavicular or AC joints3 out of 5 strength in scaption DIFFERENTIAL DIAGNOSIS: -Axillary nerve injury-Rotator cuff tear-Brachial plexus injury-Humeral head fracture-Scapular fracture FINAL/WORKING DIAGNOSIS -Scapular fracture TESTS AND RESULTS -Xray initially read as c/f low grade AC joint sprain, negative for fracture. Read in office after exam had concern for scapular fracture-CT RUE w/o contrast: nondisplaced extra-articular fracture of the scapular body extending from base of coracoid and scapular neck through inferior scapular body. Mild chronic appearing changes at distal clavicle articular surface. TREATMENT AND OUTCOMES:-Initial: Placed in shoulder immobilizer sling. Follow up 3 weeks later.-At 3 week follow up: Xray showed stable scapula with no concern for displaced fracture. Able to move fully but with 4/5 strength in scaption. Started PT with AT and progressed out of brace. Returned to play without issue 7 weeks after initial injury.