Shoulder Pain and Weakness - Weightlifting: 1160: 2:40 PM - 3:00 PM

HISTORY: 18 year old high school basketball team captain developed aching pain accompanied by weakness in left shoulder two days after a weight training session three months prior. While training he developed an intermittent stabbing pain provoked by performing bench press or flies. It was the same routine he had been using for the past three months and does not recall a specific event the initiated his symptoms. The pain improved moderately with discontinuation of his weightlifting, but the weakness progressed. He has no history of trauma, vaccination, neck pain, rash, or other neurological accompaniments. His only medication was doxycyline being taken for acne. Past surgical history includes bilateral thorascopic sympathectomies for hyperhydrosis performed on 09 August 2005.

PHYSICAL EXAMINATION: Neurological examination revealed normal mental status and cranial nerve function. Left upper extremity motor portion of exam was significant for 2/5 strength with shoulder abduction, 1/5 strength with shoulder flexion, 3/5 strength with external rotation. Deltoid, biceps, triceps, latissimus, and rhomboids showed 5/5 strength. There was also atrophy overlying entire scapula, but no winging. Sensory, DTR, Coordination, Gait were all with in normal limits. Skin exam showed no lesions or skin changes over arm, shoulder, or back.

DIFFERENTIAL DIAGNOSIS:

1. Suprascapular neuropathy

2. Rotator cuff injury

3. C5 radiculopathy

4. Upper trunk brachial plexopathy

TEST AND RESULTS: Nerve conduction of left upper extremity: left suprascapular compound muscle action potential had low PMplitude compared to right. Concentric needle examination revealed fibrillation potential and no motor unit potential activity in left suprascapular innervated muscles. There was no evidence of an upper trunk brachial plexopathy, cervical radiculopathy, or long thoracic neuropathy in the left upper extremity. The evidence was most compatible with an active, electrophysiologically severe left suprascapular neuropathy.

MRI arthrogram of left shoulder: 8mm paralabral cyst adjacent to posteroinferior aspect of labrum, not in spinoglenoid or suprascapular notch. Tear of the posterior inferior labrum. Minimal increase T2-W1 in the supraspinatus and infraspinatus muscles consistent with edema. Minimal supraspinatus tendinopathy.

FINAL WORKING DIAGNOSIS: Suprascapular neuropathy

TREATMENT AND OUTCOMES:

1. Orthopedic consultation

2. Rest from overhead activities

3. Repeat EMG 4 months from onset of symptoms

4. Possible surgical exploration and decompression if no signs of reinnervation