A 17-year-old high school student comes to urgent care with right shoulder pain. The pain started after he hit the shoulder on the ground while tackling another player during a rugby game. On examination, there is no gross deformity of the shoulders and arms. Adduction of the right arm across the torso elicits pain over the superior lateral shoulder. Range of motion of the neck and elbows and sensation of the arms are intact. Radial pulses are 2+ bilaterally. X-rays of the right shoulder and clavicle are normal. Which of the following is the most likely diagnosis?

Question

A 17-year-old high school student comes to urgent care with right shoulder pain.  The pain started after he hit the shoulder on the ground while tackling another player during a rugby game.  On examination, there is no gross deformity of the shoulders and arms.  Adduction of the right arm across the torso elicits pain over the superior lateral shoulder.  Range of motion of the neck and elbows and sensation of the arms are intact.  Radial pulses are 2+ bilaterally.  X-rays of the right shoulder and clavicle are normal.  Which of the following is the most likely diagnosis?

Quizplus · Accepted Answer

11ec25c8_d869_28b4_bc81_0d97e3f1f6bb_MD0003_00 This patient most likely has an acromioclavicular (AC) joint sprain. AC joint sprain most commonly occurs when significant force is applied to the lateral or superior shoulder, causing a sprain of the ligament that connects the acromion and the clavicle. The resultant injury can range from mild stretching to complete tear of the ligament. This type of injury is common in contact sports (eg, rugby, football), where direct shoulder trauma (eg, a fall onto the shoulder) is common. acromion and the clavicle Examination in AC sprain characteristically shows an area of maximal tenderness over the AC joint. Adduction of the arm across the body (ie, cross-body adduction test), which compresses the AC joint, provokes pain in the AC joint in the superior lateral shoulder. When the sprain results in complete joint separation, a deformity caused by superior displacement of the clavicle can be seen. X-rays are normal in mild sprains, although widened or dislocated AC joints can be seen in more severe cases. In addition to evaluating the severity of AC joint sprain, x-rays are also helpful to assess for concomitant distal clavicle and proximal humerus fractures. Management of mild cases of AC joint sprain involves immobilization with a sling, but more severe cases warrant operative management. (Choice B) Although brachial plexus injury (eg, thoracic outlet syndrome) can result from shoulder and neck trauma, it typically presents with an acute pain in the supraclavicular area that radiates down the arm. Neurologic symptoms (eg, weakness or numbness) may also be present. thoracic outlet syndrome (Choice C) Pectoralis major strain typically results from activities involving repetitive pushing movements, such as bench presses. Patients present with chest wall soreness rather than shoulder pain. (Choice D) Acute rotator cuff (eg, supraspinatus) tear can occasionally occur in young individuals due to a violent fall. However, active range of motion defects (eg, decreased abduction) are typically seen. Superior lateral shoulder pain on adduction of the arm is more consistent with AC joint sprain. rotator cuff (eg, supraspinatus) tear (Choice E) Shoulder trauma can also cause acute subacromial (subdeltoid) bursitis, but the pain is usually aggravated by abduction (or flexion with the arm internally rotated) rather than adduction. Educational objective: Acromioclavicular (AC) joint sprain results from direct trauma to the superior or lateral shoulder. Examination shows maximal tenderness over the AC joint and pain with adduction of the arm across the torso. X-rays can assess the degree of sprain and evaluate for concomitant clavicular or humeral fractures. References: Acute shoulder injuries in adults. (http://www.ncbi.nlm.nih.gov/pubmed/27419328)

A 17-Year-Old High School Student Comes to Urgent Care with Right