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PubMed1987

Athlete shoulder injuries: CT arthrographic findings.

Forty-three professional and amateur athletes with persistent shoulder pain that interfered with their sports activities were evaluated by computed tomographic (CT) arthrography. In 19 patients, glenohumeral instability (14 anterior, two posterior, three multidirectional) was diagnosed with CT arthrography based on the simultaneous presence of labral and capsular lesions. The findings were crucial in establishing the diagnosis of instability in six patients in whom the condition was not suggested or could not be confirmed clinically. Another significant injury consisted of labral lesions not associated with glenohumeral instability. These tears often involved the anterior and parasuperior segments of this structure. Other, less frequently detected lesions included segmental labral enlargement and several labra with abnormal orientation (everted labrum). Early onset of degenerative disease was present in many athletes, especially those with a long history of sports activity. CT arthrographic findings were correlated with arthroscopic or surgical results in 19 patients.

Adolescent↗
PubMed1988

Clinical aspects of shoulder injuries.

The reader is presented with the important anatomical and biomechanical aspects of the shoulder and the most commonly seen injuries of the soft tissues. Ultrasonography is most efficacious in terms of noninvasiveness, accuracy, and cost during the initial presentation by patients with complaints, physical signs, and negative roentgenograms. It allows the practitioner to make treatment decisions when therapeutic modalities have their maximum benefit, that is, as soon after the injury as possible.

Humans↗
PubMed1999

Shoulder injuries in competitive swimmers.

Sports medicine literature often refers to "swimmer's shoulder." Increasingly, however, it is evident that swimmer's shoulder is a spectrum of maladies whose underlying origins may be incidental to athletic activity. Those dealing with the treatment of swimmers should have a thorough understanding of the differential diagnosis of the shoulder, the age range of competitive swimmers, and the effects of the aging process, and age-related disease processes and should consider the possibilities of neoplasm, degenerative diseases, and acquired processes such as arthritis or metabolic diseases.

Athletic Injuries↗
PubMed1989

The diagnosis and nonoperative treatment of shoulder injuries in athletes.

The specific emphasis in this article has been directed toward the diagnosis of prevalent shoulder pathology in a young athletic population; however, as the interest in sports has blossomed in recent years now encompassing a larger age range, the physician must not neglect common pathologic conditions of the older athletes. Fastidious adherence to complete history, physical examination, and a high level of suspicion for uncommon disorders is paramount. Arthritides such as osteo, rheumatoid, septic, and lyme as well as the hematologic disorders of multiple myeloma, lymphomas, leukemia, hemophilia, and Gaucher's disease can all present with shoulder pain. Thoracic outlet syndrome, scalene syndrome, supra-scapular nerve syndrome, and quadrilateral space syndrome comprise a group of nerve compression syndromes that are becoming more apparent as our diagnostic skills improve. Yet, the most pervasive disorders in the young athlete are due to lack of shoulder stability. By understanding the delicate balance in normal shoulder between mobility and stability, the clinician is better able to conceptualize the etiology and progression of the problem, and design the optimal treatment program.

Athletic Injuries↗
PubMed2006

Throwing shoulder injury involving the anterior rotator cuff: concealed tears not as uncommon as previously thought.

PURPOSE: In throwing athletes, partial rotator cuff tears are usually located posterior to the site of the common rotator cuff tears seen in the general nonthrowing population. However, they sometimes have tears located around the anterior aspect of the supraspinatus tendon. In this study we investigated the characteristics of anterior rotator cuff tears in throwing athletes. We then compared several factors between anterior tears and posterior tears to investigate those related to the presence of anterior tears or the occurrence of such tears. METHODS: We divided 37 athletes with partial rotator cuff tears into those with anterior tears (n = 17) and those with posterior tears (n = 20). The clinical profile, range of motion and joint laxity with patient under general anesthesia, and operative findings were retrospectively compared between the 2 groups. RESULTS: Among the 17 anterior rotator cuff tears, 12 tears were confined to the anterior one third of the supraspinatus tendon. Interestingly, concealed intratendinous degenerative tears were found in 6 shoulders. These appeared to be very shallow articular-side tears located around the attachment of the greater tuberosity, but severe tears were exposed after resection of the residual capsular portion of the tendon. Posterior capsular tightness was significantly related to the occurrence of anterior tears, whereas a greater tuberosity notch was significantly related to posterior tears. CONCLUSIONS: Anterior rotator cuff tears are not uncommon in throwing athletes, and a concealed type of tear was a representative lesion. Different mechanisms may be involved in the development of anterior and posterior rotator cuff tears resulting from throwing injuries. Posterior capsular tightness might influence the occurrence of anterior tears. LEVEL OF EVIDENCE: Level IV, prognostic case series.

Athletic Injuries↗
PubMed2000

Shoulder injuries in overhead athletes. The "dead arm" revisited.

The following statements summarize this article: Three distinct categories of Type 2 SLAP lesions exist: (1) anterior, (2) posterior, and (3) combined anteroposterior. Posterior Type 2 SLAP lesions have distinct clinical and anatomic features that distinguish them from anterior Type 2 SLAP lesions. Posterior and combined Type 2 SLAP lesions can be disabling to overhead-throwing athletes because of posterosuperior instability and anteroinferior pseudolaxity. The Jobe relocation test is positive with posterosuperior pain in patients with posterior or combined anterior-posterior Type 2 SLAP lesions and is negative in patients with anterior Type 2 SLAP lesions. Rotator cuff tears are frequently associated with posterior or combined anterior-posterior SLAP lesions, are lesion-location specific, and typically begin from inside the joint as undersurface tears. Repair of posterior SLAP lesions can return overhead-throwing athletes to full overhead athletic functioning. The peel-back mechanism is a likely cause of posterior Type 2 SLAP lesions. To securely repair the posterosuperior labrum to resist torsional peel-back, sulure anchors must be placed posterior to the biceps at the corner of the glenoid. The repair must be protected against external rotation past 0 degree for 3 weeks to avoid undue premature torsional stresses on the repair from the peel-back mechanism. A tight posteroinferior capsule predisposes to Type 2 SLAP lesions in overhead athletes. Shoulders at risk for the dead arm syndrome have a marked loss of internal rotation caused by contracture of the posteroinferior capsule such that less than a 180 degrees arc of rotation is achieved with the arm abducted 90 degrees (the 180 degrees rule). Type 2 SLAP lesions that cause the dead arm syndrome in overhead-throwing athletes are most likely acceleration injuries that occur in late cocking rather than deceleration injuries in follow-through. Rehabilitation of athletes with the dead arm syndrome must include the entire kinetic chain. The root cause of the dead arm syndrome is the Type 2 SLAP lesion.

Athletic Injuries↗
PubMed2004

Clinical and functional results after floating shoulder injuries.

BACKGROUND: Good results have been reported with both operative and nonoperative treatment of floating shoulder, and discussions about an appropriate therapy of this rare entity are controversial because of small numbers of patients. METHODS: Seventeen patients with a floating shoulder were retrospectively evaluated. The treatment was nonoperative in eight patients and operative in nine. All patients were clinically examined and standard shoulder radiographs were obtained at the time of follow-up. RESULTS: All fractures healed. Five patients in the nonoperative and five patients in the operative group showed good to excellent results. The associated injuries influence the outcome of these patients significantly. CONCLUSION: Nondisplaced or less displaced floating shoulders are expected to give good results after nonoperative treatment. If mostly heavy associated injuries allow it, significantly displaced fractures should be treated operatively.

Adult↗