I have an adult son with Down Syndrome who is participating in Special Olympics. His event is the shot-put. Last week at practice he started having painful popping of the shoulder blade when he moved his arm to throw the shot-put. Now he can't lift his arm all the way overhead. What could be causing this?

A medical evaluation will be needed to find out the cause of the problem. The doctor will take this information and ask other questions to find out more about what happened. Pain with loss of muscle strength suggests a nerve injury.

Shot-put athletes can put a stretch or traction force on the long thoracic nerve causing a nerve palsy. With the arm in the overhead position, they turn the head and neck to the opposite side before throwing. With the added weight in the hand, this can put a tremendous strain on the nerve.

EMG testing of the muscles may be needed to make a final diagnosis. If it turns out there is a long thoracic nerve palsy, then treatment is started right away. Your son will have to avoid shot-put activities for awhile. Certain muscles will be strengthened while others are given a rest.

If symptoms don't go away or improve, surgery may be an option. Tendon and muscle transfers are used to help one muscle function in place of another. In some cases, weakness may persist for years.

Early diagnosis and treatment are important to avoid long-term problems. Don't delay in making an appointment for an exam.