Case report 11 13 14
This presentation is the property of its rightful owner.
Sponsored Links
1 / 15

Case Report 11/13/14 PowerPoint PPT Presentation


  • 34 Views
  • Uploaded on
  • Presentation posted in: General

Case Report 11/13/14. Tad DeWald, MD PGY-3. Disclosure. Speaker has no relevant financial disclosures. History.

Download Presentation

Case Report 11/13/14

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Case report 11 13 14

Case Report 11/13/14

Tad DeWald, MD

PGY-3


Disclosure

Disclosure

Speaker has no relevant financial disclosures.


History

History

  • A right-hand-dominant 23-year-old college male swimmer presented with persistent right shoulder pain, numbness, and paresthesia with radiation down the medial aspect of the right upper extremity. Patient stated that symptoms started gradually over a week and would only present during distances over 1,000 meters. Symptoms resolved when the athlete ceased activity. 


History1

History

  • PMH:Negative

  • Meds: None

  • Social: No alcohol/tobacco use

  • Functional: right-hand dominant, fully independent


Physical exam

Physical Exam

  • HEENT: NC, AT, PERRL, cervical spine non-tender, full AROMResp: B/L CTA CV: +S1S2, RRR, No murmurs, gallops, or rubs.   Abdomen: Soft, non-tender, non-distended, BS+

  • Skin: no rashes or ulcersExtremities: pulses 2+ throughout, no edema  Neuro/MSK: 5/5 strength throughout, sensation intact, cervical spine non-tender, full AROM

  • Patient demonstrated normal physical exam. However, patient’s symptoms were reproduced with his right arm fully abducted and externally rotated

  • Equivocal Adson’s test.

  • 5

  • 5


Differential diagnosis

Differential Diagnosis

  • Thoracic outlet syndrome

  • Peripheral nerve injury/compression

  • Impingement syndrome

  • Brachial plexopathy

  • Radiculopathy

  • Venous/Arterial Thrombus

  • Rotator Cuff pathology

  • Strain

  • Sprain


Work up

Work Up

US Duplex Venous

US Duplex Arterial

IR Angiogram

MRI

Electrodiagnostic studies

  • 8

  • 8


Rue arterial ultrasound

RUE Arterial Ultrasound

  • IMPRESSION:

  • Neutral position of the arterial system was normal. During stress views, there was elicitation of symptomatology per the patient. No appreciable change however was demonstrated in the waveform patterns of the arterial system.

  • 9

  • 9


Rue venous ultrasound

RUE Venous Ultrasound

  • IMPRESSION:

  • Normal right upper extremity venous Doppler

  • 9

  • 9


Ir angiogram upper

IR Angiogram Upper

  • IMPRESSION:

  • 1. No evidence of either venous or arterial thoracic outlet syndrome.

  • 2. No angiographic abnormality in the neutral position. However, there is compression of the bilateral axillary arteries and circumflex humeral arteries with extreme abduction and external rotation.

  • 9

  • 9


Mri right shoulder

MRI Right shoulder

  • IMPRESSION:

  • No acute abnormality. No masses seen within the quadrilateral space. Neurovascular structures appear unremarkable.

  • 9

  • 9


Electrodiagnostic studies

Electrodiagnostic studies

  • Electrodiagnostic studies did not demonstrate abnormalities in the axillary, ulnar, or median nerves with normal EMG of corresponding muscles.

  • 9

  • 9


Clinical course

Clinical Course

  • Dx- Quadrilateral Space Syndrome

  • Patient resumed activity and continued to swim competitively with modification in training duration and regimen, demonstrating improvement in symptoms.

  • The athlete will be evaluated for possible surgical decompression in the offseason.

  • 10

  • 10


Case report 11 13 14

  • TITLE: Quadrilateral Space Syndrome in a Collegiate Male Swimmer: A Case Report.

  • AUTHORS: Tad DeWald, MD, Geraldine Dapul, MD, Paul Withers, MD, Aashish Deshpande, MD, Parmod Mukhi, MD

  • INSTITUTIONS: Wayne State University/Oakwood Hospital Systems

  • 10

  • 10


Thank you

Thank you!

  • Discussion/Questions?

  • 10

  • 10


  • Login