A 15-yeаr-оld pаtient, аctive in fооtball and soccer, reports constant low back pain that worsens with repetitive kicking motions. The therapist observes that the patient is compensating with lumbar extension due to a lack of hip mobility in which direction?
SCENARIO: A 33-yeаr-оld recreаtiоnаl league baseball pitcher repоrts to your sports medicine clinic asking to have their right shoulder evaluated. History He tells you that his shoulder pain has gradually progressed over the past three months. For the past month, the pain has reached a point where it is beginning to affect his performance. He is in a recreational baseball league that plays an average of three games per week. On average, he pitches approximately 15 innings per week. He has noticed a considerable decrease in his pitching velocity. He describes his pain as usually being dull (2/10) and located across the “front” and “side” of his shoulder but becomes sharp (7/10) with overhead activities. He has noticed that his shoulder has begun to ache at night, especially when he sleeps on his right side or with his right arm up over his head. He does not recall a specific episode that caused his shoulder to begin hurting. He is employed as an accountant and has no work-related complaints. He recalls a vague history of several minor shoulder injuries playing high school and college baseball but does not remember specific diagnoses. He has not sought medical attention for any shoulder injury since he stopped playing college baseball roughly a decade ago. He denies any pain in his neck, elbow or hand and reports no neurological symptoms. Observation No obvious deformity, signs of acute edema, effusion or ecchymosis upon inspection of the right shoulder. The patient presents with a slight kyphotic lean during postural analysis. His right shoulder is slightly depressed compared to the left. He appears to present with Type 2 scapular dyskinesis upon inspection of the arm at rest and during a wall push-off. Palpation Point tenderness noted inferior to the lateral aspect of the acromion process. This same response is also present inferior to the anterior aspect of the acromion process and extends to the intertubercular groove. ROM Testing PROM P! with extension. You encounter a capsular end-feel and the patient complains of P! before reaching end range. P! with adduction. You encounter a capsular end-feel and the patient complains of P! predominantly between approximately 70-110º. P! with scaption. You encounter a capsular end-feel and the patient complains of P! predominantly between approximately 70-110º. P! with internal rotation. You encounter a capsular end-feel and the patient complains of P! before reaching end range. You note the involved side has approximately 10-to-15º less motion compared with the uninvolved side. AROM P! with AROM flexion. The patient complains of P! before end range. Minor scapular hiking is also apparent. P! with AROM abduction. The patient complains of P! before end range and predominantly between approximately 70-110º. Minor scapular hiking is also apparent. P! with AROM scaption. The patient complains of P! before end range and predominantly between approximately 70-110º. Minor scapular hiking is also apparent. P! with AROM external rotation. RROM P! with RROM flexion. Rated 4/5. Minor scapular hiking is also apparent. P! with RROM abduction. Rated 4/5. Minor scapular hiking is also apparent. P! with RROM scaption. Rated 4/5. Minor scapular hiking is also apparent. P! with RROM external rotation. Rated 4/5. Structural (or Stress) Tests Active impingement (or Painful arc) Positive for p! Neer impingement Positive for p! Hawkin's-Kennedy Positive for p! P! increases further into horizontal adduction Impingement relief Positive for relief of symptoms Speed's (or Biceps or Straight-arm) Positive for p! and slight weakness Uppercut (or Railroad whistle) Positive for p! (Jobe) Empty can Positive for p! and slight weakness External Rotation Lag Test Just positive for p!, no lag present Neurovascular Tests No significant findings noted. AT RESPONSE: Based on these ensemble findings, what is your diagnosis? DIRECTIONS: Your response must follow best practices for health record documentation (i.e., provide concise, specific, and accurate information that another clinician could easily read and interpret). It is expected that your text entry will include correct spelling. You may (and are encouraged) to use common abbreviations and acronyms linked to anatomical and medical terminology when appropriate.
SCENARIO: A 33-yeаr-оld recreаtiоnаl league baseball pitcher repоrts to your sports medicine clinic asking to have their right shoulder evaluated. History He tells you that his shoulder pain has gradually progressed over the past three months. For the past month, the pain has reached a point where it is beginning to affect his performance. He is in a recreational baseball league that plays an average of three games per week. On average, he pitches approximately 15 innings per week. He has noticed a considerable decrease in his pitching velocity. He describes his pain as usually being dull (2/10) and located across the “front” and “side” of his shoulder but becomes sharp (7/10) with overhead activities. He has noticed that his shoulder has begun to ache at night, especially when he sleeps on his right side or with his right arm up over his head. He does not recall a specific episode that caused his shoulder to begin hurting. He is employed as an accountant and has no work-related complaints. He recalls a vague history of several minor shoulder injuries playing high school and college baseball but does not remember specific diagnoses. He has not sought medical attention for any shoulder injury since he stopped playing college baseball roughly a decade ago. He denies any pain in his neck, elbow or hand and reports no neurological symptoms. AT RESPONSE: Based on the patient’s history, what corresponding conditions are you considering in the first step of differential diagnosis? DIRECTIONS: Bullet your individual text entries. Your entries must be concise, specific, and accurate. Your entries must include correct spelling. You may (and are encouraged) to use common abbreviations and acronyms linked to anatomical and medical terminology when appropriate.
During а fооtbаll gаme, a running back falls tо the ground with the shoulder adducted, internally rotated, and flexed. The athlete immediately reports severe shoulder pain and is unable to move the arm. Based on this mechanism of injury, which of the following shoulder injuries is most likely?