A 14-year-old athletic girl with a history of intermittent aches and pains following sports presented with right shoulder pain after a fall during basketball. On examination, tenderness over the anterolateral deltoid to the mid-humeral shaft was noted, extremes of shoulder movement were limited, but no deformity was present. No other injuries were present. A right shoulder X-ray was requested (figure 1).
Questions 1 1. What abnormalities are visible on the shoulder X-ray?
Question 2 2. What is the most likely diagnosis?
Fracture of the surgical neck of the humerus.
Subluxation of the shoulder.
Severe vitamin D deficiency.
Question 3 3. What investigation is most likely to reveal the underlying diagnosis?
Y-scapula view of the right shoulder.
Serum bone profile.
Radioisotope bone scan.
MRI of the right shoulder.
Skeletal survey, including full spine X-ray.
Serum 25-hydroxyvitamin D levels.
Question 4 4. How would you manage this patient?
Answers can be found on page 2.
- bone disease
- general paediatrics
- bone metabolism
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Contributors JXS prepared the manuscript. FY critically reviewed and edited the manuscript.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
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