You should be considering shoulder separation, rotator cuff injury, shoulder sprain, clavicle fracture and simple contusion.

Examination:

On examination active abduction and forward flexion were restricted to 60 degrees with sharp increase of pain. The acromioclavicular joint was tender and swollen. There was slight ecchymosis over the AC area. Upper extremity neurologic was normal. There was no neck pain. The distal tip of the clavicle was slightly more prominent than the other side.

Question:
What is your working diagnosis at this point?
What other x-ray laboratory or advanced imaging would you order?




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