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Endgames Spot Diagnosis

A painful shoulder after a seizure

BMJ 2019; 366 doi: (Published 08 August 2019) Cite this as: BMJ 2019;366:l4511
  1. Tobenna Jerris Oputa, specialist registrar, trauma and orthopaedics1,
  2. Ronnie Davies, consultant, trauma and orthopaedics2
  1. 1Pennine Acute Hospitals, UK
  2. 2Central Manchester University Hospitals, Manchester, UK
  1. Correspondence to T Oputa tobi{at}

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 …

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