Anatomy clinical correlates Quiz: Ace Your Exams

A 25-year-old man presents to the emergency department after being tackled during a football match. The patient was knocked to the ground by another player. He experienced sudden-onset sharp pain in the abdomen and left shoulder. He subsequently lost consciousness. Before the incident, the patient had been experiencing fatigue and sore throat for two weeks. He has no significant past medical history and was screened with an ECG prior to playing football. At arrival, temperature is 37.0°C (98.6°F), blood pressure is 90/60, and pulse is 110/min. Physical examination reveals diffuse abdominal guarding and rigidity. Elevation of the legs leads to the patient grimacing in pain and grabbing his left shoulder. Palpation of the left upper abdominal quadrant also causes the patient to grimace in pain. The bilateral tonsils are swollen and erythematous, and there is bilateral posterior cervical lymphadenopathy. Which of the following best explains this patient’s shoulder pain?