Bilateral Superomedial Scapular Pain And Swelling In A Young Basketball Player

Abstract

HISTORY: A fifteen year old otherwise healthy basketball player developed pain and swelling over bilateral superomedial scapula after starting a new weight lifting program. The team’s strength coach, unfamiliar with training high school athletes, instructed performance of Romanian dead lifts with >100 lbs. He described tight, aching pain rated at 4/10 in severity. Denied neck or upper limb radicular pain, focal weakness, sensory loss, and constitutional symptoms. He rested from weight lifting and at time of presentation ten days later, the swelling had resolved. He and family had questions regarding diagnosis and return to play. Coaches prohibited his interaction with teammates due to lack of participation in assigned weight training. PHYSICAL EXAMINATION: He was 6’8” tall, weighed 180 lbs. No swelling, skin changes, atrophy, or winging. Mildly tender to palpation at insertion of bilateral levator scapulae and middle trapezius bilaterally. Normal, symmetric, and pain free cervical and shoulder ROM. Normal strength, sensation, reflexes. DIFFERENTIAL DIAGNOSIS: 1) Muscle strain 2) Traction apophysitis 3) Scapulothoracic bursitis 4) Dorsal scapular nerve entrapment TEST AND RESULTS: Limited diagnostic ultrasound of the periscapular region was performed in clinic using an 18-5 MHz linear array transducer. This revealed cortical irregularities at insertion of the left levator scapulae. This was associated with hyperemia on doppler, increased vascular flow on SMI, and partial beam penetration of the cortex. Sonopalpation tenderness over levator scapulae insertion bilaterally. FINAL WORKING DIAGNOSIS: Traction apophysitis of bilateral levator scapulae TREATMENT AND OUTCOMES: 1) Rest from weight lifting, ice PRN. 2) Educational letter written to coaching staff. 3) Physical therapy included 3D biomechanical analysis and EMG, flexibility for shoulder, cervical and thoracic regions with strengthening of posterior scapular stabilizers and core musculature and proprioception activities. Progression targeted sport specific, age-appropriate weight training for in-season play. 4) Return to play if pain ≤2/10 in severity. 5) At two month follow-up, he made strength gains, improved mechanics, and is fully practicing in workouts and engaged in Nationally Sponsored AAU Basketball Circuit competition.