Atypical Back Injury in Masters Weightlifter

Abstract

HISTORY 48 year old British Caucasian weightlifter sustained an acute injury to his right axilla during training for the 2004 World Masters Weightlifting Championships in Baden, Austria. While lifting 110 kg in the snatch, he felt a tearing sensation with immediate swelling and bruising in the right axilla. He used ice, stretching, and Etoxocorib to enable continued training for the competition. He denied any prior shoulder or back injuries, use of anabolic steroids or antibiotics, autoimmune or degenerative conditions, or any direct trauma to the right axilla. As a gold medalist in his weight class, he was drug tested by the International Weightlifting Federation doping control per protocol. PHYSICAL EXAMINATION Well developed, well nourished athletic male with little body fat in moderate discomfort. Cranial nerves II-XII grossly intact. Neck supple without bruits or lymphadenopathy. Hypermuscular sternocleidomastoid and trapezius but full range of motion of the neck. Negative Spurling exam. Examination of upper extremities revealed full active range of motion in all planes with moderate discomfort on the right, good internal and external strength, normal deep tendon reflexes, and no sensory deficits bilaterally. Negative Hawkin's, Neer's, Speed's, Job's, O'Brien's, Gerber Lift Off, scapular winging, AC joint tenderness, Apprehension, Spring test, Yergason's, and Sulcus signs. Positive large, tender, non-ecchymotic, non-pulsatile mass in the right axilla with a palpable defect in the right latissimus dorsi distal to the palpable mass. Normal chest wall excursion with no evidence of ecchymosis or deformity. Abdominal and lower extremity exam unremarkable except for hypermuscularity. DIFFERENTIAL DIAGNOSIS Latissimus Dorsi Rupture Latissimus Dorsi Hematoma Brachial Artery Aneurysm or Dissection Serratus Anterior Rupture TEST AND RESULTS XR and MRI or ultrasound of the mass recommended but not completed per patient communication 3 weeks post-competition. FINAL WORKING DIAGNOSIS Suspected Latissimus Dorsi Rupture with Hematoma. TREATMENT AND OUTCOMES Recommended ice, rest with no lifting for 2–3 weeks following the competition, continued Cox-2 inhibitor use, avoidance of regular NSAIDs for the first 24 hours, and imaging. The patient reports resolution of the pain with overhead arm movements 3 weeks post-competition with plans to rehabilitate with light weights.