Case 1

You are attending the annual Homecoming football game and witness the following injury. The player is helped off the field and does not return to play for the remainder of the game.

 

Image credit: D. Bardana

 

Later that day, you encounter the player as a patient in the Emergency Room where you are working. He is a right-handed fourth-year Engineering student who complains of pain in the right shoulder subsequent to this fall. He is reluctant to abduct or elevate the right arm as he reports that these motions cause pain and a "crunching" feeling. You notice an obvious deformity (see picture below). The patient is most tender just lateral and antero-inferior to the deformity.

 

Image credit: L. Davidson

Questions for discussion:

1. What anatomic structures do you suspect are injured?
2. What features of the physical exam will help you make a diagnosis?
3. What imaging would be helpful and what would you expect to see?

 

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