Shoulder pain in a football player

A 19-yr-old college football player presents with a 1.5-yr history of right shoulder pain and associated easy fatigability of the right arm. The history is significant for an automobile accident 3 yr prior to presentation in which the right shoulder struck the dashboard of the car. An extensive workup proved unremarkable. Treatment included multiple trials of anti-inflammatory medication and extensive physical therapy without benefit. The patient underwent a first rib resection for thoracic outlet syndrome with significant relief of symptoms. Thoracic outlet syndrome (TOS) may mimic other more common causes of shoulder and arm symptoms. Diagnosis may be difficult as tests are often nonconfirmatory. Conservative treatment usually is adequate. In resistant cases, surgery may be indicated.