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Puzzling Periscapular Pain - Page #1
 

Author: Kiyomi Goto, DO
Co Author #1: Kathryn Gloyer
Senior Editor: Mandeep Ghuman, MD, FAMSSM
Editor: Allison Schafer, DO

Patient Presentation:
19 year old female rugby athlete with 9 days of left posterior shoulder and periscapular pain.

History:
A 19 year old female rugby athlete presented to the training room for evaluation of 9 days of left posterior shoulder and periscapular pain. <br>She had performed a tackle with her left shoulder during a contact drill then immediately experienced sharp pain in the the ipsilateral shoulder. <br>Pain increased with shoulder movement and deep inspiration. <br>She denies neck pain, upper extremity paresthesias or weakness.

Physical Exam:
On examination, the bony landmarks of the cervical spine are nontender. <br>She has full and painless range of motion of the cervical spine. <br>She has localized pain in the neck with Spurling maneuver but no radicular pain. <br>She has a slightly kyphotic posture. <br>On shoulder exam, she has a mild deficit in forward flexion and abduction due to pain, but special testing was unremarkable. <br>She has tenderness over the rhomboid and levator scapulae as well as the lower border of the trapezius. <br>There is appreciable hypertonic musculature of the scapular stabilizers. <br>She has 5/5 strength throughout the bilateral upper extremities. <br>Her distal neurovascular exam is intact in the upper extremities.

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