Golfer with Brachial Neuritis Misdiagnosed Essay

1. A 12 year-old boy fell while playing basketball. The physician explained that the head

HPI: Ms. Smith presents to the office with bilateral shoulder stiffness and lateral elbow pain in right arm. The patient has been suffering shoulder stiffness for over 2 years. The symptom developed gradually after she started using her computer more at her work place; she had to hold her telephone between her shoulder and head while typing information on computer. The pain in right elbow stated about 8 months ago with gradual onset. The patient does not recall any trauma to the shoulder and elbow. She has been diagnosed as tennis

2. During inspection of the patient’s affected shoulder, name at least three key clinical aspects that you need to observe on both shoulders that would suggest any pathology or abnormality on the shoulders. From the three clinical aspects that you observed, explain what each of the findings would indicate concerning the pathology of the shoulder. For example if the shoulder is

Russell Carrington is a 25 year old right handed relief pitcher for the MLB team the Baltimore Orioles. Carrington has been playing baseball since he was seven years old and this was his third season in the Major Leagues. Carrington was at the mound and in the motion of throwing a fastball, when he felt a “pop” in his overhand motion. He dropped to his knees and clinched his right shoulder in pain. Athletic trainers came onto the field an upon examination Carrington stated his arm felt like it was “dead” and felt like it was “catching”. Carrington was seen by the team physician. She performed ROM exercises, strength, and stability tests on his shoulder and examined his neck and head to ensure pain wasn’t coming from a pinched nerve. She concluded that further testing and imaging was necessary. Carrington had an X-ray and MRI done on his shoulder and he was diagnosed with a type II SLAP (Superior Labrum Anterior and Posterior) lesion. He didn’t want surgery done because he would miss the remainder of the season and possibly the next, so doctors prescribed non-steroid anti-inflammatory medication and five months physical therapy to strengthen the shoulder capsule. After completion of physical therapy, the pain didn’t improve and arthroscopy surgery was recommended.

I interviewed Jimmy Johnson; he suffers from chronic pain from many years of work and hard labor. Jimmy was employed for 15 years at a factory that manufactures insulation; there he frequently lifted over 100 pound bags of material. After so much time had passed of heavy lifting Jimmy’s right shoulder tendons began to tear and fray terribly, which frequently happens to people who do hard labor over such a long period of time. Doctors performed surgery on Jimmy’s shoulder, at the age of 49 and left him with only ten percent of his arm and shoulder mobility and flexibility. The cause of his chronic pain is now due to the surgery and the tearing of his tendons in his shoulder: also, numerous other injuries he sustained over his lifetime. A time after his surgery he was prescribed Vicodin and today takes Oxycodone, which treats higher levels of pain than Vicodin. Without his medication of prescription pills Jimmy’s pain would be almost unbearable. He only takes the needed amount each day for his pain management and tries his hardest to not abuse the narcotic drugs like many do (Johnson).

Two years ago on a crisp October afternoon following school, I walked to the training room expecting a normal day for us. There would be the tapping of ankles, wrist, and thumbs, along with rehabilitation exercises and the whines and complains of athletes who would sit in the whirlpool for various injuries. After changing into sports medicine attire and putting my books up I was asked to take a framed object next door to the athletic director’s office. While patiently waiting for him to finish a meeting with

Consider June Wilson, a 17-year-old swimmer referred to your outpatient clinic for neck pain 3 days before the state high school swimming championships in which she is scheduled to compete. June and her parents will expect you, the movement expert, to be able to answer their questions. June might ask you:

She said, she fell last night while playing volley ball. She landed on her right shoulder and heard a pop sound, too. She did not take any pain medicines. She applied icepack and felt burning pain. This was an interesting musculoskeletal assessment case. We assessed her right shoulder and compared with the left one. We found slight dislocation of the shoulder joint. She had good circulation in her right arm, no swelling noted in the right hand and the capillary refill was < 2 secs. Mary said, since she had burning pain, it could be a nerve injury, too. We also noted a slight swelling of her trapezius muscle on the right side. She complained of pain on palpation. Mary applied a sling to her right arm to keep it elevated. She may need an MRI to see the damage. Mary sent her to the urgent care. She told her that, since she heard the popped sound, the ER or Urgent care doctor can replace it. It will be a painful procedure, and she will need a strong pain medicine. She gave her the note for her teacher and asked her friend to drive her to the urgent

The patient wants to also update me as far as the arm pain he mentioned last time. He says his left arm is feeling better now. He is noticing that his right shoulder is hurting at times, especially in certain positons such as while he is sleeping and if he has his arm raised over his head while he is lying down. He had no specific injury or trauma. He is not aware of anything that makes it better or worse. He is not using any medication for it thus far. He would be interested in having

S: TM missed 3 days of her ESI visit, related holidays, but she did continue with ice and plan of care as instructed at home. The TM reports her pain is 4/10, and the pain is described as aching type pain; the pain is intermittent. TM is currently taking Ibuprofen 800 mg tab, 1 tab 2 times a day and Acetaminophen 500 mg tab 2 tabs as needed for shoulder pain to manage her pain and it does help to decrease her pain to 2-3/10. TM denies any loss of ROM or sensation of the right arm; denies any tingling or numbness.

Komblatt, the patient underwent extensive chiropractic treatment with 87 sessions from 10/07/11 through 07/11/12. It was opined that it does appear that the IW ha s undergone excessive passive-chiropractic treatment referable to both lumbar spine and right shoulder. It was further opined that the IW has reached MMI regarding the lumbosacral strain and contusion of the right shoulder within approximately 6-8 weeks post injury. Appropriate treatment would have consisted of aggressive right shoulder and low back rehabilitation to include aerobic conditioning, strengthening exercises involving the right upper extremity, lumbar spine and core, and resumption of normal recreational and work activities within 6-8

Based on the progress report dated 10/07/16, the patient presents for evaluation of carpal tunnel syndrome on the right shoulder.

Client reported this week she is having shoulder pain. She also submitted MRI Rx. With the following findings:

• Exercises to strengthen and stretch your shoulder. You may be given the name of a physical therapist.

^8,5 ASI occurs when the arm is in adduction with the shoulder internally rotated. The biceps complex pulley, also known as a capsuloligamentous complex, adjoins the anterior glenoid causing injury when in extreme motions. With the PSI, the pulley is put into risk with abduction and external rotation on the posterosuperior glenoid. ^8 PSI is also associated with partial-thickness tears on the deep side of the articular surface of the rotator cuff. ^5 This can be a common cause for a peel-back mechanism associated with a SLAP lesion. ^8 Peel-back mechanisms can be produced many different ways, but are mostly seen with a SLAP lesion or internal impingement. These can occur when the shoulder is placed into abduction and extreme external rotation with a torsional force added to the labro-bicipital complex that is at the base of the biceps on the posterior superior labrum. ^1,5 This causes fatigue and failure of the humeral head that rotates medially over the upper rim of the glenoid fossa creating a shearing force. ^1,5 Increased superior labral strain in overhead athletes occurs during the late-cocking phase of throwing when arm is externally rotated. ^1