Unilateral Shoulder Weakness and Visual Deformity in a Young Military Recruit.

Previously published Photo Quizzes are now featured in a mobile app. Get more information at http:// www.aafp.org/afp/apps. A healthy 18-year-old man with no significant medical history presented with right shoulder weakness and pain that had been present for one week. He had recently started a daily intensive physical fitness regimen similar to military boot camp. The week before his symptoms began, he had a particularly grueling workout session that involved multiple repetitions of push-ups, inchworms, and bear crawls that the patient found difficult to complete. He had weakness in his right arm and could not lift it over his head, and he had dull, achy pain in his right shoulder. He had no numbness or tingling. He noticed that his right shoulder blade was protruding compared with the left side. The examination revealed an obvious deformity (Figure 1). He was unable to abduct his arm above 90 degrees without assistance. He had full passive range of motion. Otherwise, his musculoskeletal and neurologic examination findings were normal, except for 4/5 strength in shoulder abduction.