Clinical Commentary: Diagnostic Corner

Management of acute shoulder pain in an adolescent lacrosse athlete: a case report.

Author: Malone T

Acute onset of shoulder pain in adolescent athletes typically is related to trauma. The subject of this case report, a 13 year-old male, was injured when he collided with another athlete while his right arm was extended. He experienced immediate onset of significant right shoulder pain. Manual assessment in the emergency department revealed anterior tenderness and loss of function due to pain - most notably limitations in both active internal rotation and abduction. A plain film showed a radiographic density anterior to the humeral head but a donation site (where a bony avulsion may have occurred) was not delineated.   Magnetic resonance imaging clearly identified a lesser tuberosity avulsion (thus the site of origin of the bony material) encompassing the insertion of the subscapularis muscle with retraction of approximately one centimeter. Open surgical repair (reduction and fixation) was performed with excellent results.

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