Author: Tanner Eiben, DO
Co Author #1: Dr. Patrick Smith, MD
Senior Editor: Kristine Karlson, MD, FAMSSM
Editor: Ryan Reese, DO

Patient Presentation:
The patient is a 15-year-old left hand dominant male with history of bilateral congenital anomalous thumb malformations who presented to a primary care sports medicine physician two days following a left shoulder injury. The patient was making a tackle in a high school football game when he described a forceful abduction and external rotation of the left shoulder. This caused an anterior shoulder dislocation. An emergency medicine physician was attending the game and reduced the patients shoulder. He presented to clinic for evaluation after dislocation. He never dislocated his shoulder previously.

History:
Past medical history: Hypothyroidism, controlled asthma and bilateral anomalous thumb malformations <br>Past surgical history: None <br>Family history: Mother reported epilepsy and had been on divalproex sodium with folic acid during her pregnancy with the patient <br>Medications: Levothyroxine 75 mcg daily, Albuterol sulfate inhaler 2 puffs as needed <br>Allergies: No known drug allergy

Physical Exam:
General: Well developed, well nourished <br>Hands: Bilateral thumb hypoplasia with distal displacement of the thumb bases and underdevelopment of thenar eminences <a href="CaseStudyImages/CS1AreTwoHeadsBetter-1015.jpg" title="Case Photo #1" data-lity><b>Case Photo #1</b></a> <a href="CaseStudyImages/CS2CS1AreTwoHeadsBet-1015.jpg" title="Case Photo #2" data-lity><b>Case Photo #2</b></a> <br>Neuro: DTRs 2+ in bilateral upper and lower extremities. Normal sensation over bilateral deltoid <br>Beighton score: 4/9 (negative) <br>Left shoulder: <br>Active range of motion: flexion 180 degrees, abduction 110 degrees, external rotation at side 25 degrees, external rotation with abduction to 85 degrees with pain and apprehension <br>Rotator cuff strength 5/5 <br>Special tests: O'Brien's positive, trace sulcus sign, load and shift grade 3, apprehension positive, relocation positive <br>Right shoulder: <br>Normal range of motion and strength <br>Load and shift grade 2 <br>Trace sulcus sign <br> <br>Reported physical exam was from 21 days after initial injury. His initial physical exam was limited due to patient apprehension and pain.

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