Weightlifter has pain, weakness in arm, shoulder – Let’s diagnose

A 38-year-old man presented to the emergency department after a recent injury while weightlifting. He recounted feeling a “snapping” sensation in his right axillary region shortly after performing a bench press at maximal exertion at the gym. He was experiencing pain and weakness in his left arm and anterior shoulder muscles, along with decreased range of motion.

On physical examination, ecchymoses and soft tissue swelling were noticeable over his anterolateral chest and medial upper arm region, and one nipple appeared lower than the other. Internal rotation resulted in a medialization of the chest musculature during contraction. In addition, weakness in arm adduction and internal rotation were present during forward flexion. When asked about medication history, the patient admitted to anabolic-androgenic steroid (AAS) / testosterone use for the past 4 years.

What’s the diagnosis?

  1. Clavicle fracture
  2. Pectoralis major rupture
  3. Rotator cuff tear
  4. Burners and stingers

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