Andrew is a 35-year-old engineer who presents with three days of right-arm weakness and pain.

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<p>Andrew is a 35-year-old engineer who presents with three days of right-arm weakness and pain.</p><p>He reports sudden onset of symptoms while bench pressing about 100kg at his home gym, associated with a sudden ‘pop’ sound.</p><p>Some bruising and swelling developed the following day.</p><p>Andrew is otherwise well, with no past history of note. He takes no medications and denies anabolic steroid use.</p><p>On examination, Andrew appears well, with normal vital signs. There is slight bruising on the right upper arm, mild swelling and tenderness across the right chest.</p><p>In the prayer position (pictured), the right nipple appears lower than the left and there is dimpling of the chest wall near the right anterior axilla.</p><p>Right shoulder range of motion is normal, with reduced strength in adduction and internal rotation. The remainder of the upper-limb examination is normal.</p>

Dr Kate Kelso is a GP and medical editor at Australian Doctor.