Shoulder Pain - Football

HISTORY: This is a 16-year-old left hand dominant male linebacker and running back for his High School team. During a game, while on the ground another player fell on his right shoulder. He felt immediate pain and had trouble forward flexing his right shoulder and his flexing his right elbow. Initially he had paresthesia down his right arm, but that resolved by the next day. At the game, the athlete was placed in a sling. Over the subsequent days, his pain started to improve. No previous injuries to his right shoulder. Noncontributory past medical history. PHYSICAL EXAMINATION: Examination in clinic reveals FROM of the right shoulder and elbow. No obvious deformities of the right clavicle or shoulder. 5/5 strength in scaption, internal and external rotation. Negative Hawkins, Neers, and O’Brien’s special tests. Tender to palpation over the Bicepital groove. Positive Speed’s test. Neurovascularly intact. DIFFERENTIAL DIAGNOSIS: 1. Proximal Humeral Fracture 2. Rotator Cuff Tendinopathy 3. Biceps Tendon Hematoma 4. Biceps Strain 5. Subluxation of Biceps Tendon TEST AND RESULTS: Right Shoulder Ultrasound: anechoic fluid around an intact long head tendon of the biceps.- Right Shoulder X-Ray: No fractures SUBSEQUENT CLINICAL COURSE Over the following 2 weeks, the athlete developed worsening anterior right shoulder pain. He had been working with a physical therapist and an athletic trainer who noticed weakening of the right shoulder. Repeat physical examination demonstrates 4/5 strength in scaption and external rotation. Additionally, his Hawkin’s and Neers test were positive. SUBSEQUENT TESTS AND RESULTS:-Right Shoulder MRI: The long head of the biceps tendon is anteriorly subluxated out of the bicipital groove. It is positioned anterior to the subscapularis tendon. Notable edema around the tendon. Tear of the transverse humeral ligament. FINAL WORKING DIAGNOSIS: Subluxation of the Biceps Tendon TREATMENT AND OUTCOMES: - Athlete continued to improve after the MRI. Allowed to return to play as pain allows. - As athlete remained symptomatic he was referred to orthopedics for surgical correction after completion of the season. - Acetaminophen for pain.