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Case Study; Francesca is an ice hockey player and keen swimmer. She has started to experience shoulder discomfort and reduced range of motion.

Case Study; Francesca

Francesca is 5’9” tall and has an athletic build, developed through her enjoyment of fitness and being a competitive three-sport athlete. One of her favourite leisure-time activities is swimming.

Recently Francesca had mentioned that her right shoulder was sore. As an ice hockey player, she felt that she no longer had as much range of motion in

her right shoulder when she was shooting and she experienced some general discomfort in that shoulder after practices as well as some shooting pains during more strenuous activities. Additionally, her parents noticed that there was a curve to her spine that had not been there before and that she looked “twisted.”

Upon examination by an orthopaedist and an athletic trainer, it was noted that Francesca had a decrease of 15 degrees in active right external shoulder rotation, 11 degrees of internal rotation, and her right scapula sat lower on the thoracic wall when compared bilaterally. Via palpation, it was noted that there were several significant “knots” in her thoracic and posterior shoulder regions. These same areas also were very “tight” and tender when palpated. X-rays of the spine revealed that she had a Cobb angle (angle of measurement of the spine’s vertebrae from side to side) of 32 degrees.


  • Based on this scenario, what would be the differential diagnosis you would consider for Francesca's problem?

  • What are several anatomical soft tissues in the area of pain that could be contributing to Francesca's pain and restriction of motion?

  • What is the mechanism of injury for Francesca?

  • By using your palpation skills, what specific structures should be palpated on a patient with this complaint?

Adapted from Robert Stow, PhD, ATC, LAT University of Wisconsin – Eau Claire

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