A painful shoulder after a seizure

A 25 year old man presented to the emergency department with pain and reduced movement in his left shoulder following a generalised tonic clonic seizure. He had no medical history and no history of seizures. On examination, his level of consciousness was 15/15 on the Glasgow coma scale, and he had no neurological abnormalities. His left shoulder was notably deformed, with a posterior prominence, anterior flattening, rounding of the shoulder, and prominence of the coracoid process anteriorly. He held his left arm in internal rotation at the …