A 15-year-old right-hand-dominant female competitive softball player presented 3 days after an injury sustained while playing softball. Although considered a pitcher, she was playing third base at the time of the injury. While she was in a squatting position to tag an opponent sliding into base, the opponent’s helmet directly impacted her left anterior chest wall. To execute the tag, the patient’s arm was placed into a hyperextended position. Immediate left arm pain, paresthesia, and extremity coolness were apparent, and she had deep left subclavicular pain.
Numbness and tingling of the left arm were still present but improving. The patient was then placed into a shoulder immobilizer and was instructed to follow up at the local orthopaedic clinic.
During her initial clinic visit, the patient indicated that she was experiencing pain localized to the left medial scapular border and in the left clavicular region. She also had continued symptoms of mild numbness and tingling of the left arm but noted some improvement in the intensity of the symptoms. On palpation, the clavicle was nontender, but the patient did experience pain deep along the upper ribs superior to the clavicular shaft. The peripheral nerves were intact, and strength and reflexes were considered normal. Full range of motion was observed in both upper extremities, and the patient experienced mild pain with full flexion of the left shoulder. No vascular or neurologic compromise was elicited with provocative testing.
A radiograph from an outside facility is shown in Figure 1. Magnetic resonance imaging (MRI) scans showed increased inflammation to the brachial plexus with hypertrophy and inflammation of all 3 scalene muscles (Figs. 2-A and 2-B).
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