Case 2: Shoulder Pain In 7-Year-Old Girl

Ashley L. Scheffer, MD*2. Palka R. Patel, MD†3. John J. Manaloor, MD‡ 1. *Department of Child Health, University of Arizona College of Medicine-Phoenix; Department of Pediatric Critical Care, Phoenix Childrenu0027s Hospital, Phoenix, AZ2. †Uganda Site Director, Global Primary Care Program, MGH Global Health, Massachusetts General Hospital, Boston, MA3. ‡Clinical Pediatrics; Pediatric Antimicrobial Stewardship Program, Ryan White Center for Pediatric Infectious Diseases and Global Health, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, INA previously healthy, fully vaccinated 7-year-old girl presents with a 3-day history of pain in her right shoulder, refusal to move her right arm, and temperature to 39.4°C (103°F). She complains of pain at the superior and posterior areas of her right shoulder, over her right scapula, and at the right lateral chest in the mid-axillary area. She maintains her neck in a slightly flexed and laterally rotated position. The review of systems is otherwise negative. She is eating and drinking well and denies sweats, chills, malaise, or antecedent viral respiratory tract infection.She was evaluated 2 days earlier for the same symptoms. At that time, the right shoulder and arm had no abnormalities and she had full range of motion of the right shoulder. The radiograph of the right shoulder was read as normal. She was discharged from the urgent care facility with a diagnosis of muscle strain and a recommendation to use ibuprofen as needed for pain.On physical examination today, her temperature is 39.4°C (102.9° F), heart rate is 130 beats per minute, and respiratory rate is 14 breaths per minute. She appears anxious and remains very still on the examination table. She maintains a rigid posture when sitting up, keeping her neck slightly flexed and rotated to the right. She refuses to move her shoulder. One hour after provision of acetaminophen, clinicians elicit full passive range of motion of her right shoulder but she continues to refuse active range of motion. Upon examination of the neck, 5 to 10 degrees of active motion in any direction is elicited. Her gait is normal. Aside from tachycardia, …