Case 2

A 22-year old mechanic presents with intermittent right shoulder discomfort and 'weakness'. He has had symptoms for several years, worse when he works overhead. He reports feeling an uncomfortable popping sensation when his arm is elevated and externally rotated. He has given up playing baseball in a recreational league because of these symptoms. He does not report any specific history of injury, although admits that as a teenager he was involved in many different sports and had many visits to the Emergency room for a variety of sports-related injuries.

On examination, the patient appears health and muscular. There is no deformity and he has full range of motion of both shoulders in all directions. The physical examination maneuver pictured below reproduces his symptoms.

 

Image credit: D. Bardana

 

 

Questions for discussion:

1. What is the most likely diagnosis based upon this information?
2. What anatomic structures may be abnormal in this individual?
3. What imaging would be helpful and what would you expect to see?

 

return to top | previous page | next page