Shouldering The Burden: A Case Of Instability, Stiffness, And The Road To Recovery

HISTORY: A 31-year-old right-hand-dominant female recreational boater presented with left shoulder pain and range of motion (ROM) deficits following a fall from a boat 6 weeks ago. Her brother tried to catch her, causing hyperextension of the left shoulder. She experienced immediate pain and restricted movement. Initial urgent care X-rays were unremarkable. She was managed with a sling for 2 weeks and Tylenol. Pain improved slightly, but stiffness and limited ROM persisted, affecting daily activities. No prior shoulder injuries. PHYSICAL EXAM: Left shoulder exam showed no bony deformities. Active and passive range of motion were restricted in all planes, mostly notably external rotation limited to 10 degrees compared to 80 degrees on the non affected side. Minimal scapular dyskinesia was present. Provocative tests (Neer’s, Hawkin’s, Kim, O’Brien’s, apprehension, and relocation) were positive. Sensation was intact. Strength was full except for pain-limited weakness in resisted external rotation. DIFFERENTIAL DIAGNOSIS: 1. Rotator Cuff Tear 2. Anterior Shoulder Dislocation 3. Labral Tear 4. Shoulder Impingement Syndrome 5. Acromioclavicular Joint Sprain or Separation FINAL/WORKING DIAGNOSIS: Left anterior shoulder dislocation with Hill-Sachs lesion complicated by post-traumatic adhesive capsulitis TESTS AND RESULTS: X-rays of the left shoulder showed no acute dislocation; Hill-Sachs deformity on internal rotation. MRI of the left shoulder revealed a Hill-Sachs lesion, potential Bankart injury, and mild rotator cuff tendinopathy. CT of the left shoulder confirmed Hill-Sachs lesion without displaced Bankart lesion. TREATMENT AND OUTCOMES: 1. Physical therapy to regain ROM, scapular stabilization, and strengthen rotator cuff given apprehension and instability. 2. Nonoperative management prioritized due to no large bony Bankart lesion. Anti-inflammatories recommended for symptom control. 3. Surgical intervention (arthroscopic stabilization with capsulorrhaphy and possible remplissage) discussed if instability persists post-therapy. 4. Continued follow-up to assess progress in ROM and stability with long term goal to return to safe recreational boating.