Insidious Onset of Shoulder Girdle Weakness

Shane A. Vath, Brett D. Owens, Paul D. Stoneman

DOI: 10.2519/jospt.2007.2249

STUDY DESIGN: Resident’s case problem. BACKGROUND: An 18-year-old man presented to physical therapy 3 days after insidious onset of painless left shoulder girdle weakness. DIAGNOSIS: Decreased light touch sensation was noted on the lateral left shoulder. In addition, weakness was present with shoulder abduction, flexion, external rotation, and internal rotation. Results of magnetic resonance imaging and radi­ography of the cervical spine, brachial plexus, and left shoulder were normal. Electromyography and nerve conduction velocity study findings were con­sistent with axillary nerve palsy. The results of the physical examination and diagnostic studies were most consistent with axillary nerve mononeuropa­thy, probably caused by traction or pressure due to wearing a pack while hiking or firing a weapon. DISCUSSION: With sling protection, limitation of physical activity, and gradual return to progres­sive resistance exercises, the patient had full return of strength and function 2½ months after onset of symptoms. The differential diagnosis for shoulder girdle weakness should be well under­stood by physical therapists. This knowledge will help the therapist promptly identify the cause of shoulder girdle weakness and initiate appropriate treatment. If the condition requires further evalu­ation or treatment by another healthcare provider, prompt identification of pathology will allow appro­priate timely referral.  

J Orthop Sports Phys Ther. 2007;37(3):140-147. doi:10.2519/jospt.2007.2249 

KEY WORDS: axillary nerve mononeuropathy, pack palsy, rucksack palsy

Knowledge of the differential diagnosis for shoulder girdle weakness will help the physical therapist promptly identify the cause of such weakness and initiate appropriate treatment or ensure timely referral to another healthcare provider.

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