Young Adolescent With Restricted Arm Motion During a Preparticipation Physical Exam

A healthy 15-year-old right-hand dominant football player presented to the clinic for a preparticipation examination (PPE) with an exam notable for reduced right shoulder range of motion. The patient reported no complaints, including no pain. Upon questioning, he noted a remote non-sports related injury to that shoulder with unremarkable radiographs at that time. Subsequent X-ray imaging showed a bony abnormality thought to be consistent with an osteochondroma. However, advanced imaging identified it as a heterotrophic ossification center that required a complex, multidisciplinary surgical team to correct. This case of a high school football player’s routine PPE that resulted in surgery highlights not only whether sport participation is safe, but also the importance of direct, specific language that asks about the history of any injuries, rather than specifically sports related.