Latissimus Dorsi and Teres Major Injuries

Abstract

Latissimus dorsi and teres major tendon injuries are an uncommon, but under-recognized source of shoulder pain and weakness in baseball players, specifically pitchers. These injuries can be difficult to diagnose on history and physical examination, but are typically accompanied by pain and weakness to resisted adduction, extension, and internal rotation with the shoulder in the abducted and externally rotated position. Imaging is also challenging as the typical shoulder magnetic resonance imaging protocol does not have a wide enough field of view to include the insertions of the latissimus dorsi or teres major, nor their anatomic courses along the posteroinferior scapula. Treatment for latissimus/teres injuries is often based on tear severity and can include operative and nonoperative measures. Nonoperative management involves a period of shutdown from throwing with or without the use of biologic augmentation followed by a return to throwing protocol. Operative treatment involves repair of the torn latissimus and/or teres to their humeral insertion followed by an extensive rehabilitation program and progression to throwing. Return to play following successful treatment of latissimus/teres injuries is encouraging with many players returning to the same level as before their injury.