T HROWING SHOUL DE R CASE Midshaft Clavicle ORIF Nonunion Spe r o G Kar as, MD E mor y Spor ts Me dic ine Ce nte r Team Physicians
MAY 4, 2017 • 16 ye a r o ld fe ma le pre se nts fo r se c o nd o pinio n fo r rig ht sho ulde r pa in. • Hig h sc ho o l, 1 st a nd 3 rd b a se , so ftb a ll pla ye r with c o lle g ia te sc ho la rship o ffe rs. • Atra uma tic pa in sta rte d la st No ve mb e r, a nd she to o k re st o f fa ll se a so n o ff b ut pa in re c urre d whe n she sta rte d to thro w a g a in. • 4 we e ks o f PT , g le no hume ra l CSI a nd pro g re ssive thro wing pla n b y initia l pro vide r b ut sympto ms re c urre d. Team e mo ryhe a lthc a re .o rg / o rtho Physicians
PHYSICAL E XAM • Mo de ra te te nde rne ss to pa lpa tio n o ve r a nte rio r sho ulde r pro xima lly • F ull a nd symme tric ra ng e o f mo tio n, mild pa in with te rmina l fo rwa rd e le va tio n • Symme tric stre ng th e xa mina tio n • Symme tric sc a pula r mo tio n with no wing ing • Po sitive imping e me nt te sting , Spe e d a nd O’ Brie ns te sting Team e mo ryhe a lthc a re .o rg / o rtho Physicians
Team e mo ryhe a lthc a re .o rg / o rtho Physicians
ANY T HOUGHT S? Team e mo ryhe a lthc a re .o rg / o rtho Physicians
PL AN • Dia g no se d with b ic e ps te ndinitis a nd fe lt tha t this wa s the c a use o f he r sympto ms mo re so tha n he r SL AP te a r o n e xa m a nd ima g ing • Pla n – CSI into b ic e ps she a th – NSAI Ds – Physio the rpa y – F o rma l inte rva l thro wing pla n – No c o mpe titive thro wing until June Team e mo ryhe a lthc a re .o rg / o rtho Physicians
CL INIC VISIT - 9/ 14/ 17 • Re po rts wo rse ning sho ulde r pa in a nd po pping a sso c ia te d with thro wing . She re po rts she c o mple te d I T P b ut ha d pa in thro ug ho ut it. • Co mple te d the ”T hro we r’ s 10” e xe rc ise s a t le a st o nc e pe r we e k. • L o ng disc ussio n tha t I still b e lie ve he r pa in is c o ming fro m b ic e ps te ndinitis ra the r tha n a SL AP te a r b ut the surg ic a l tre a tme nt wo uld b e the sa me fo r b o th. • Sc he dule d fo r a rthro sc o pic b ic e ps te no to my with sub pe c to ra l te no de sis Team e mo ryhe a lthc a re .o rg / o rtho Physicians
Team e mo ryhe a lthc a re .o rg / o rtho Physicians
3 WE E K F OL L OW UP • Physic a l E xa m – I nc isio ns he a le d with no sig ns o f infe c tio n – F o rwa rd e le va tio n to 180 de g re e s – Ab duc tio n/ E xte rna l ro ta tio n to 80 de g re e s – Ab duc tio n/ I nte rna l ro ta tio n to 45 de g re e s • Pla n – D/ C sling , PT fo r sc a pula r sta b iliza tio n a nd c uff stre ng the ning – Re turn in 8 we e ks to like ly sta rt inte rva l thro wing pla n Team e mo ryhe a lthc a re .o rg / o rtho Physicians
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