The authors report a case of quadrilateral space syndrome in a baseball pitcher. The diagnosis was made by means of subclavian arteriography performed with the arm in abduction and external rotation. This entity is a rare cause of shoulder pain caused by occlusion of the posterior humeral circumflex artery in the quadrilateral space.

Our results indicate that the diagnostic performance of MR imaging and MR arthrography of the shoulder depends on the training level of the performing radiologist, with sub-specialized musculoskeletal radiologists having a better diagnostic performance than general radiologists.

Surgical repair of a complete pectoralis major tendon rupture at the humeral insertion has superior results compared to nonoperative treatment. To our knowledge, a proximal humerus shaft fracture occurring at the site of the bone trough and cortical drill holes after a pectoralis major tendon rupture repair has not been reported in the literature.A 45-year-old man sustained an acute left pectoralis major tendon rupture at the humeral insertion while performing a bench press maneuver. He underwent acute surgical repair. Approximately 8 weeks postoperatively, the patient fell from a standing height and sustained a proximal humerus shaft fracture through the repair site at the bone trough. Three days after the fracture, the patient underwent open reduction and internal fixation of the proximal humerus shaft fracture and exploration of the pectoralis major tendon repair. The fracture was found to be at the level of the repair site, and the pectoralis major tendon was completely intact to the distal fragment. The fracture healed uneventfully, and the patient regained full motion and strength of his extremity with no limitations.Any type of surgical fixation that creates a hole in the humerus or decreases the cross-sectional area such as a bone trough creates a stress riser. Patients undergoing pectoralis tendon repair that involves violating the humerus with a bone trough or hole have a slight risk of postoperative humerus fracture, especially if sustaining an early traumatic event such as a fall.

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Rotator cuff injuries in sports are usually a result of microtrauma from repetitive movements. Classic, or primary, impingement results directly from overhead motions, and secondary impingement is related to underlying shoulder instability. A variety of physical maneuvers are used to assess pain, muscle weakness, and shoulder stability. The workup also includes plain x-rays, supplemented by other imaging tests if a cuff tear is suspected. Nonoperative treatment, which may include steroid injections, is often effective for an inflamed rotator cuff tendon. Surgery is indicated if the patient has no improvement after at least 6 weeks of physical therapy.

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Patients with postoperative adhesive capsulitis of the shoulder who are unable to reach their PT treatment goals with a standard protocol of PT may benefit from the addition of HIS to their treatment regimen. HIS could be a valuable adjunct to PT for treating postoperative adhesive capsulitis in appropriate patients.