em@3am

A 2-year-old female with a past medical history of failure to thrive presents for evaluation of right arm pain. The mother states that the patient was recently started on mupirocin for a spot on her right forearm the day prior. Since then, the mother states she has noticed a “hard spot” on the patient’s right clavicle. Mother denies any recent trauma or falls and also reports a temperature at home of 37.8° C. Per chart review, the patient was recently discharged a week prior after a 6-day admission for failure to thrive. Vital signs include temperature 37.0° C, HR 136 bpm, RR 32 breaths/minute, and blood pressure of 99/57 mmHg. The head is atraumatic and normocephalic. Auscultation of the heart reveals a regular rate and rhythm, and lungs are clear to auscultation bilaterally.  Physical exam is notable for guarding of the right upper extremity with induration overlying the proximal right clavicle with minimal surrounding erythema. There are no step-offs or bruising throughout the bilateral upper extremities. The patient has 2+ bilateral radial pulses. There is decreased active range of motion of the right shoulder which appears to be secondary to pain. She has full range of motion of all other joints.