Thursday-Abstracts

Official Journal of the American College of Sports Medicine
1791 May 30, 3:55 PM - 4:15 PM
shoulder Pain in a Golfer
Jothi Murali1 , Michel Arcand2 . 1Brown University/Rhode Island
Hospital, Providence, RI. 2Center for Orthopaedics, Johnston, RI.
(No relationships reported)
hIsTOry: A 67-year-old man played 18 holes of golf. That evening, he woke up
from sleep with pain in his right shoulder. He did not feel any sensation that his
shoulder had dislocated. He went to the emergency room for evaluation, had xrays
taken, was given a sling, and came to the office for follow-up one week later. He
reported the pain to be on the superior aspect of his shoulder and denied any numbness
or tingling.
PhysICaL EXaMINaTION: Obvious deformity with prominence and ecchymosis
over the distal clavicle. Tenderness to palpation over the distal clavicle. Positive Neer
and Hawkins impingement signs. Pain with cross-body adduction. No subluxation or
dislocation. No rotator cuff weakness.
PhysICaL EXaMINaTION:
1. Acromioclavicular arthritis
2. Subacromial bursitis/impingement syndrome
3. Rotator cuff tear
4. Glenohumeral arthritis
5. Acromioclavicular separation
TEsT aNd rEsuLTs: Xrays show a type III AC joint separation.
FINaL WOrKING dIaGNOsIs: Type III AC joint separation.
TrEaTMENT aNd OuTCOMEs: The patient was slowly weaned out of the sling
and allowed to use his arm as tolerated. At one month follow-up, the patient was
started on physical therapy for passive, active-assisted, and active range-of-motion
with progression to strengthening as tolerated. He will be seen again at a ten-week
follow-up to evaluate his progress. It was discussed with the patient that he could be
successfully treated non-operatively with good results. With failure of non-operative
management, a coracoclavicular ligament reconstruction would be done.
1792 May 30, 4:15 PM - 4:35 PM
shoulder Pain - Basketball
Yogesh V. Kolwadkar, Paul Sherbondy, Peter H. Seidenberg.
Penn State University, State College, PA. (Sponsor: Scott
Magnes, FACSM)
(No relationships reported)
hIsTOry: 23 year - old left hand dominant male fell on his abducted right shoulder
while playing basketball. He had the sensation that the shoulder dislocated and
spontaneously relocated. He also experienced dead arm syndrome that resolved 2 days
later. He continued to play, but later had to stop because of pain. He had a previous
instability injury 2 years ago treated with physiotherapy, and remained asymptomatic
until the current episode.
PhysICaL EXaMINaTION: He had full AROM in forward flexion and abduction,
but lacked 3 vertebral levels with adduction and IR. He had mild tenderness in the
posterior aspect of shoulder and scapular winging. He had positive apprehension
and relocation signs as well as a positive O’Brien’s test. Sensation and strength were
normal. His Speed’s test and sulcus sign were negative.
dIFFErENTIaL dIaGNOsIs
1. Bankart lesion
2. HAGL lesion
3. SLAP lesion
4. Rotator cuff tear
TEsT aNd rEsuLTs:
Vol. 45 No. 5 Supplement S347
X- ray - AP, supraspinatus outlet and axillary lateral were normal.
MRI ARTHROGRAM - Hill - Sachs and soft tissue Bankart lesions.
FINAL WORKING DIAGNOSIS: Recurrent anterior - inferior instability of right
shoulder, soft tissue Bankart lesion, HAGL lesion, SLAP lesion, Hill - Sachs lesion.
TrEaTMENT aNd OuTCOMEs:
1. Arthroscopic SLAP repair, open Bankart and HAGL lesion repairs, loose body
removal, no treatment for non- engaging Hill - Sachs lesion.
2. 6 months post - op: pain free, full AROM except 5 degrees loss of ER.
3. Continue home exercise program to maintain ROM and progress with strengthening.
4. He may chip and putt golf balls, swim, and perform low intensity basketball
shooting.
5. No contact or collision activities.
6. Reevaluate in 2 months for return to play decision.
1793 May 30, 4:35 PM - 4:55 PM
shoulder Injury-Motocross rider
Kelly L. Evans-Rankin, Robert Hosey, FACSM, Rebecca
Mercer. University of Kentucky, Lexington, KY. (Sponsor: Robert
Hosey, FACSM)
(No relationships reported)
hIsTOry: A 15-year-old male motocross rider sustained a right shoulder injury
after falling off his motorbike. He took a jump and landed on the ground square onto
his right shoulder with his arm in adduction. He had immediate pain to his shoulder
and shortness of breath with deep inspiration. There was no numbness, weakness,
tingling, or paresthesias of the upper extremity. He initially presented to the ER where
radiographs showed only a widened acromioclavicular (AC) joint . He was placed in a
sling and given analgesics.
Two days later, he presented to the sports medicine clinic with continued pain at the
sternoclavicular (SC) joint, increased shortness of breath, and dysphagia.
PhysICaL EXaM: Exam noted mild tachypnea, and soft tissue swelling at the SC
joint. He had TTP over the AC joint, mid-clavicle, and SC joint. The medial aspect of
the clavicle was felt to be slightly depressed at the SC joint on palpation. He had full
active range of motion (ROM) of neck but neck extension and flexion were painful. He
had overall decreased ROM of his right shoulder secondary to pain. Lungs were CTA
with good air movement. He had 2+ distal pulses and sensation intact to light touch.
PhysICaL EXaMINaTION:
1. AC Sprain/Separation
2. SC Sprain/Dislocation
3. Rib Fracture
4. Clavicle Fracture
5. Sternal Fracture
6. Pneumothorax
TEsTs/rEsuLTs
Chest A/P and lateral radiographs (CXR):
-widening of the right AC joint, concerning for type II AC separation.
CXR (2 days later):
-symmetric appearing SC joints, although minimally rotated limiting evaluation.
CT of chest without contrast:
-posterior displacement of the medial end of the clavicle near the trachea.
FINaL/WOrKING dIaGNOsIs:
Posterior SC dislocation
AC separation
TrEaTMENT aNd OuTCOMEs:
1. Operating room for closed reduction under anesthesia.
2. Normal appearing SC joint with slight widening of AC joint on post reduction films.
3. Placed in sling and given prescription analgesics.
4. Overhead ROM activities and pendulum exercises started 10 days post-op.
5. Clavicle and serendipity view radiographs showed no change at 1 month.
6. Cleared to ride at 2 months post-op.
7. Cleared to race and participate in full contact sports at 4 months.
1794 May 30, 4:55 PM - 5:15 PM
shoulder Injury - Men’s Ice hockey
Matthew Hall 1 , Giselle Aerni 1 , Robert Arciero 2 . 1 University
of Connecticut, Hartford, CT. 2 University of Connecticut,
Farmington, CT. (Sponsor: Thomas Trojian, FACSM)
(No relationships reported)
hIsTOry: 21 year old male freshman ice hockey player presents with shoulder
instability. He reports a history of frank anterior dislocations and is status-post an
arthroscopic repair in 2009. He began having instability episodes again approximately
two years after the procedure. These events have increased in frequency, and he is
now reporting instability with trivial events such as sleeping and once with sneezing.
He has continued to play through several hockey seasons without significant pain or
limitations.
PhysICaL EXaMINaTION:
Examination of the shoulder revealed no asymmetry or muscle atrophy. He had mild
tenderness to palpation over the greater tuberosity and biceps tendon. There was full
Abstracts were prepared by the authors and printed as submitted.
Thursday, May 30, 2013