Posterior shoulder lesions in throwing athletes

Abstract

Posterior shoulder lesions have terminated the careers of throwing athletes.We wish to present four case reports of posterior shoulder lesions which underwent operative intervention in an attempt to alleviate the individual's symptomatology and permit a return to throwing. The four cases are those of active professional baseball players whose careers were all but terminated due to intractable posterior shoulder symptoms during and after throwing. None of the individuals responded to multiple conservative regimens.The basic operative approach in the four cases (F. W. J., primary surgeon) was as follows: with the patient prone and the involved extremity draped free, an incision was made over the scapula spine laterally; the deltoid was reflected from the spine and split in the interval between the middle and posterior thirds; the posterior capsule and glenoid were reached between the interval of the infraspinatus and teres minor; the capsule was opened longitudinally; the lesion was identified and removed (Fig. 1); closure of the capsule and various layers was carried out.Postoperatively a sling was used for 1 week, followed by progressive active range of motion exercises for 3 weeks. Throwing was commenced at 8 to 10 weeks. Pitching began at three-quarter speed at 12 to 14 weeks and at full speed at 4 to 5 months. CASE REPORTSCase 1-G. N. This 25-year-old right-handed professional pitcher initially presented with a complaint of right shoulder pain of 2-year duration. The patient's initial problem was noted 2 years earlier and was characterized by a gradual onset of diffuse pain while throwing with significant velocity. The patient noted pain throughout the 1972 season in the posterior shoulder region. Temporary relief was gained with rest and injections of local analgesic and steroid compounds. The patient's performance level during the 1972 season was below normal. Due to persistence of symptoms, the patient was unable to participate in the 1973 season. Over the course of time, the pain localized deep to the area of the junction of the posterior middle third of the right deltoid. With attempts at throwing, the patient had pain as well as a feeling of weakness. There was no history of paresthesia nor radiculitis.Various oral medications brought about no relief, nor did multiple injections of analgesics and steroids by other physicians-approximately 10 in number. The patient noted the pain when placing the arm in the abducted and externally rotated position with the hand behind the head, as well as when placing the involved extremity across the chest in an adducted, internally rotated position.Physical examination revealed a normal range of motion, with approximately 15° more external rotation on the involved extremity than on the uninvolved. No atrophy was noted. Manual moAddress requests for reprints to Dr. Stephen J. Lombardo, 575 East Hardy Street, Inglewood, California 90301.

Surgical Technique Arthroscopic Posterior Glenoidplasty for Posterosuperior Glenoid Impingement in Throwing Athletes

“…These were distinct from typical Bennett lesions as described by several authors [3,12,16] and we presumed they would cause painful abutment on the spur (Fig. 2).…”

“…We also noticed a posterior spur was common in throwing athletes. There had been reports of open resection of posterior ossifications in throwing athletes with unreproducible results [2,12,13,16]; however, Ozaki et al [16] reported an improvement in all parameters in a series of seven baseball pitchers and Meister et al [13] suggested 10 of 18 players returned to their previous level of throwing. In 1996, we thus decided to generalize the glenoidplasty in arthroscopic treatment of PGSI [10].…”

Posterior shoulder pain in throwing athletes with a Bennett lesion: Factors that influence throwing pain

“…Several hypotheses have been proposed regarding the mechanisms of this lesion, such as traction on the posterior joint capsule or triceps tendon during the follow-through phase of throwing, posterior impingement of the humeral head on the glenoid in the late-cocking phase, or a wringing action during the acceleration phase. [1][2][3]6,7 In addition, local irritation of the joint capsule and axillary nerve by the bony spur and internal impingement have been suggested as possible causes for how the bony spur induces posterior shoulder pain in throwing. [6][7][8] The pathologic significance of the Bennett lesion is still controversial, and which type of Bennett lesion induces throwing pain is not clear.…”

Subakromiyal sıkışma sendromu

“…Lombardo ve ark. [49] 1977'de, açık yaklaşımla tedavi ettikleri hastalarda posterior omuz kapsü-lü ve çevresi yumuşak dokulardaki fibrotik değişiklikleri göstermişlerdir. Andrews ve ark.…”