Shoulder Injury In A Hockey Player

HISTORY: An 18-year-old high school hockey player presented to the clinic with a two day history of right shoulder pain. The pain began after he was hit on the front of his right shoulder while playing hockey, and he subsequently felt a noticeable “pop” in his shoulder. Since the incident, the patient experienced constant, achy pain in the anterior part of the right shoulder, with no radiation down the upper extremity. The pain improved with rest, but worsened with certain shoulder movements such as flexion and internal/external rotation, limiting his overall range of motion of the right shoulder. Patient denied any previous injuries or surgeries. PHYSICAL EXAMINATION: Physical exam of the right shoulder revealed nontender AC or SC, no swelling or deformities. There was full active range of motion but pain on internal/external rotation. Sensation and pulses were intact and strength was 5/5 except the supraspinatus was 4/5. Stability testing revealed 1+ Load/Shift tests, 1+ Sulcus test, Positive Apprehension/Relocation, and positive O'Brien's/Crank tests DIFFERENTIAL DIAGNOSIS: AC Joint Injury Rotator Cuff Injury Reverse Hill-Sachs Lesion TEST AND RESULTS: Three-view radiographs of the right shoulder: — Normal alignment and no fracture. Type I acromion, and no degenerative or soft tissue changes T2 Axial MRI of right shoulder: — Glenohumeral joint effusion, anterior humeral head bone contusion (reverse Hills-Sachs lesion), posterior labral tear, and articular sided tear of subscapularis with muscle belly edema FINAL/WORKING DIAGNOSIS: Reverse Hills-Sachs lesion TREATMENT AND OUTCOMES: Surgical and non-operative options discussed with patient who opted for conservative treatment Physical therapy initiated and PRP injection administered in right glenohumeral joint Post PRP rehabilitation protocol began with gradual resistance training and cardiovascular conditioning Patient did not return to playing hockey for the remainder of the season