Shoulder Injury - Occupational

HISTORY: A 25-year-old man with history that includes shoulder subluxations during pole vault in high school, woke up with atraumatic left shoulder pain. He currently works in construction and is right arm dominant. The pain resolved the day of onset but returned the following morning. He located the pain to the area of the scapula. He also noted weakness and decreased range of motion secondary to the pain. Icy Hot and massage therapy did not provide any relief. He was eventually referred to physical therapy which improved his range of motion and pain but did not improve his weakness. He was seen again four months after onset of pain. PHYSICAL EXAMINATION: Inspection in clinic demonstrated atrophy of the left supraspinatus and infraspinatus fossae and scapular dyskinesia compared to contralateral shoulder. Active external rotation at the shoulder was 90 degrees on the right compared to 70 degrees on left. Hawkin’s impingement test resulted in pain. His strength was reduced to 4/5 with shoulder abduction and 3/5 with shoulder external rotation. The sensation was intact throughout his left arm. DIFFERENTIAL DIAGNOSIS: 1) Cervical radiculopathy 2) Rotator cuff tendinopathy 3) Compression of suprascapular nerve TESTS AND RESULTS: Multiple view left shoulder radiographs- No fracture or malalignment and mildly elevated humeral head MRI left shoulder- Posteroinferior labral tear with labral cyst Electroneuromyography- Severe left suprascapular mononeuropathy WORKING DIAGNOSIS: Neuralgic amyotrophy TREATMENT AND OUTCOMES: 1) Case was discussed with neurologist who was involved with EMG. 2) He was not able to continue with physical therapy due to external circumstances. 3) Referred to Physical Medicine and Rehabilitation for ongoing evaluation and management with appointment pending.