Saturday Morning Cartoons
A 12-year-old boy enters your sports medicine clinic complaining of pain in the right shoulder. He has been the star pitcher on his baseball team for the past five months. He has been working hard pitching every month of the year to prepare for this season. He initially noted some decreased velocity in his pitching but has noted pain for the past month. He has not pitched for the past two weeks. His examination show tenderness over the greater tuberosity of the right humerus along with weakness and pain with empty can testing. What is the diagnosis?
What is Little League Shoulder?
A 30-year-old female mountain climber presents to your sports medicine clinic with complaints of fatigue, headache and myalgias over the past two months and notes tenderness throughout her shoulder girdle and hips. She has seen two other sports physicians in town who have diagnosed her with fibromyalgia. On your physical exam you notice a rash on her arm, which resembles the target sign. What is the risk factor for this disease?
(A) History of fluoroquinolone use
(B) History of eating disorder
(C) Intravenous drug use
(D) Hiking in the northeast United States
What is hiking in the NE US?
What is the most common nerve injury in glenohumeral shoulder dislocations?
(A) Suprascapular nerve
(B) Axillary nerve
(C) Long thoracic nerve
(D) Radial nerve
What is Axillary Nerve?
Pouring out a soda can
What is empty can test?
A 65-year-old female with past medical history of hypothyroidism and Type II Diabetes Mellitus comes to your clinic complaining of left shoulder pain and limited range of motion for the past three months. No trauma. She has tried to rest the shoulder and has taken some anti-inflammatories with minimal relief. On exam, she is neurovascularly intact. Actively and passively, she is able to abduct her arm 90 degrees, forward flex 90 degrees, and externally rotate 30 degrees. She has positive impingement signs. What is the most likely diagnosis?
(A) Cervical radiculopathy
(B) Full thickness rotator cuff tear
(C) Biceps tenosynovitis
(D) Adhesive capsulitis
What is Adhesive Capsulitis?
A 16-year-old female volleyball player presents with a two month history of gradually increasing, painless weakness in her right shoulder with overhand serve, weakness with external rotation testing, and atrophy in the infraspinatus muscle. What is the nerve most likely involved it this scenario?
(A) Axillary nerve
(B) Long thoracic nerve
(C) Suprascapular nerve
(D) Musculocutaneous nerve
What is suprascapular nerve?
A 16-year-old male pole vaulter presents with left shoulder pain. His exam reveals normal range of motion and normal strength with pain with both tests. He has no pain on AC joint compression testing or shoulder impingement testing. He has severe pain in the area of the upper trapezius, rhomboids, and paraspinal musculature. Radiographs of the left shoulder reveal the cause of pain. It is confirmed by CT scan of the area. What is the cause of his pain?
(A) Rotator cuff tendonitis
(B) Lung cancer
(C) Stress fracture of the first rib
(D) Acromial-clavicular joint sprain
What is a Stress fracture of the first rib?
You are evaluating a 14yo quarterback who was driven to the ground by an opposing player. A sideline evaluation revealed tenting of the skin around the distal end of the clavicle. This type of AC joint separation would require a referral to whom?
What is referral to orthopedic surgery?
Near to the ear
What is Neer's test?
This is the most painful phase of adhesive capsulitis?
What is the freezing phase?
A 14 year old martial arts athlete receives a forceful kick high to the right side of his chest. He complains of immediate pain and shortness of breath with a tightness in his throat making it difficult to swallow. What is the most likely diagnosis?
(A) Distal clavical fracture
(B) Chest wall contusion
(C) Posterior sternoclavicular joint dislocation
(D) Acromioclavicular joint separation
What is posterior sternoclavicular joint dislocation?
A 21-year-old collegiate freestyle distance swimmer presents for evaluation of right upper arm swelling and discomfort for the last two weeks. He states that his pain began as a feeling of heaviness, but has developed into a more consistent ache in the last week. During that time, he has noticed that his right arm appears swollen compared to the left. He denies a history of acute injury, or of a history of prior injury to this shoulder. He has no significant family or personal past medical history. On examination, you note that the right upper arm is 1.5 cm larger in diameter in comparison to the left. The arm is somewhat dusky in appearance and the veins appear dilated. There is mild tenderness to palpation diffusely across the biceps and proximal shoulder. There is no limitation in range of motion of the shoulder. He has 5/5 strength on testing of all the muscles of the rotator cuff and the biceps. He has a normal radial pulse. His neurologic exam is normal. What is the most likely diagnosis?
(A) Rotator cuff syndrome
(B) Paget-Schroetter syndrome
(C) Muscular thoracic outlet syndrome
(D) Suprasinatus rupture
What is Paget-Schroetter Syndrome?
A 17yo male HS baseball pitcher presents with pain and instability in the throwing shoulder. Positive apprehension test with positive relocation. Positive O'Brien's Test. The MRI shows this abnormality along the proximal humeral head.
What is Hill-Sachs Lesion?
Bird's beak
What is Hawkin's Test?
A 68 year old female presents with an achy shoulder for the last 3 months. Her AROM and PROM is equal and limited. Shoulder X-rays are normal. While she does not have hypothyroidism, she does have this medical condition that is commonly associated with her shoulder pathology:
What is Diabetes?
You are called onto the field while covering a college football game to evaluate a 15-year-old player who complains of numbness and tingling in his right arm which started while making a tackle on the previous play. No bony or soft tissue tenderness in his shoulder or neck. His symptoms are worse with side-bending of his neck to the right. After initial evaluation, you walk the athlete to the sideline, at which time he states that his symptoms are totally gone. He wants to return to the game. What is the diagnosis?
A. Transient Quadriplegia
B. Stinger
C. Cervical Spinal Stenosis
D. Cervical Disc Herniation
What is Stinger?
A right hand dominant male baseball pitcher has developed swelling and heaviness in his throwing arm that began during spring training. He has had an occasional experience with this in the past, but it had always gone away spontaneously. However, now he is having pain that he did not have before. He is still experiencing swelling and notices a slight color change in his arm. What sign is this?
A. Aaron's sign
B. Urschel's sign
C. Zico's Sign
D. Murray's Sign
What is Urschel’s sign?
A 14yo baseball pitcher is found to have proximal humeral physeal stress fracture. What is the next step in management?
A. cortisone injection
B. change positions
C. complete rest until asymptomatic; which can take 3 months
D. start physical therapy
What is complete rest until asymptomatic...?
Putting a scarf on
What is Cross-Arm Test?
There are over 3 million manual wheelchair users in the United States. It is estimated that up to 76% of these individuals experience shoulder pain. To reduce the burden on their upper extremities, which of the following adjustments to propulsion technique is advised?
(A) Increase contact angle
(B) Decreased contact percentage
(C) Shorten push stroke
(D) Increase cadence
What is increase contact angle?
An 16-year-old male baseball pitcher presents with a 1 month history of fatigue and weakness in his throwing arm. His symptoms gradually worsen with increasing pitch counts and will resolve with rest. He reports normal sensation in his hands but reports his right hand will feel cool after he has finished pitching. Which of the following provocative maneuvers may recreate his symptoms if he has subclavian artery compression?
(A) Roo's stress test
(B) Tinel's test at the wrist
(C) Spurling's maneuver
(D) O'Brien's Test
(A) Roo's stress test
An 18yo male footballer arrives in your clinic wanting clearance to return back to football. He has had 3 stingers over the 3 years; 2 on the right and 1 on the left. Today, he is asymptomatic and back to baseline, except you are able to reproduce symptoms with axial load. You decided to proceed with this type of treatment plan:
A. Allow him return to play
B. Dissuade him from playing football
C. Referral to PT
D. Hold from play, obtain MRI, and refer to neurosurgeon
What is answer D
This factor would increase the risk of non-union for a mid-shaft clavicular fracture.
A. male gender
B. young age
C. presence of comminution
D. no shortening
What is presence of comminution?
This test can be a clue for a labral tear which can be considered a two-part exam, having to do with the direction of the thumb.
What is O'Brien's Test?
Please demonstrate on your teammate proper reason, accurate location, and direction of needle with another teammate.