T HROWING SHOUL DE R CASE Midshaft Clavicle ORIF Nonunion Spe r - - PowerPoint PPT Presentation

Team Physicians

Spe r

• G Kar

as, MD E mor y Spor ts Me dic ine Ce nte r

T HROWING SHOUL DE R CASE

Midshaft Clavicle ORIF Nonunion

Team Physicians

e mo ryhe a lthc a re .o rg / o rtho

MAY 4, 2017

• 16 ye a r o ld fe ma le pre se nts fo r se c o nd
• pinio n fo r rig ht sho ulde r pa in.
• Hig h sc ho o l, 1st a nd 3rd b a se , so ftb a ll pla ye r

with c o lle g ia te sc ho la rship o ffe rs.

• Atra uma tic pa in sta rte d la st No ve mb e r, a nd

she to o k re st o f fa ll se a so n o ff b ut pa in re c urre d whe n she sta rte d to thro w a g a in.

• 4 we e ks o f PT

, g le no hume ra l CSI a nd pro g re ssive thro wing pla n b y initia l pro vide r b ut sympto ms re c urre d.

Team Physicians

e mo ryhe a lthc a re .o rg / o rtho

PHYSICAL E XAM

• Mo de ra te te nde rne ss to pa lpa tio n
• ve r a nte rio r sho ulde r pro xima lly
• F

ull a nd symme tric ra ng e o f mo tio n, mild pa in with te rmina l fo rwa rd e le va tio n

• Symme tric stre ng th e xa mina tio n
• Symme tric sc a pula r mo tio n with no

wing ing

• Po sitive imping e me nt te sting , Spe e d

a nd O’ Brie ns te sting

Team Physicians

e mo ryhe a lthc a re .o rg / o rtho

Team Physicians

e mo ryhe a lthc a re .o rg / o rtho

ANY T HOUGHT S?

Team Physicians

e mo ryhe a lthc a re .o rg / o rtho

PL AN

• Dia g no se d with b ic e ps te ndinitis a nd

fe lt tha t this wa s the c a use o f he r sympto ms mo re so tha n he r SL AP te a r

• n e xa m a nd ima g ing
• Pla n

– CSI

into b ic e ps she a th

– NSAI

Ds

– Physio the rpa y – F

• rma l inte rva l thro wing pla n

– No c o mpe titive thro wing until June

Team Physicians

e mo ryhe a lthc a re .o rg / o rtho

CL INIC VISIT

• 9/ 14/ 17
• Re po rts wo rse ning sho ulde r pa in a nd

po pping a sso c ia te d with thro wing . She re po rts she c o mple te d I T P b ut ha d pa in thro ug ho ut it.

• Co mple te d the ”T

hro we r’ s 10” e xe rc ise s a t le a st o nc e pe r we e k.

• L
• ng disc ussio n tha t I

still b e lie ve he r pa in is c o ming fro m b ic e ps te ndinitis ra the r tha n a SL AP te a r b ut the surg ic a l tre a tme nt wo uld b e the sa me fo r b o th.

• Sc he dule d fo r a rthro sc o pic b ic e ps

te no to my with sub pe c to ra l te no de sis

Team Physicians

e mo ryhe a lthc a re .o rg / o rtho

Team Physicians

e mo ryhe a lthc a re .o rg / o rtho

3 WE E K F OL L OW UP

• Physic a l E

xa m

– I

nc isio ns he a le d with no sig ns o f infe c tio n

– F

• rwa rd e le va tio n to 180 de g re e s

– Ab duc tio n/ E

xte rna l ro ta tio n to 80 de g re e s

– Ab duc tio n/ I

nte rna l ro ta tio n to 45 de g re e s

• Pla n

– D/ C sling , PT

fo r sc a pula r sta b iliza tio n a nd c uff stre ng the ning

– Re turn in 8 we e ks to like ly sta rt inte rva l

thro wing pla n