Paper # 197: Clinical and 3T MRI Evaluation of High Performance Junior Elite Overhead Athletes: Basis for a Preventive Shoulder Training

Abstract

Asymptomatic high performance elite junior volleyball-players and javelin-athletes already demonstrate structural changes in their dominant shoulders. These early changes implicate the need of specific prevention training for shoulder function in junior overhead athletes. A posterosuperior impingement (PSI) is frequently seen in the dominant shoulder of overhead athletes. Javelin and volleyball are overhead sports with repetitive high loading patterns. This results subsequently in relevant prevalence of shoulder pathologies in the adult athlete. However, there is still a lack of clinical and imaging-based data with respect to clinical findings in a-/ oligosymptomatic junior elite athletes even though basic approaches for injury prevention should specifically focus on this age group. The aim of this study was to evaluate clinical and imaging findings in the dominant shoulder of high performance competitive junior javelin and volleyball athletes. This is supposed to provide the basis for the development of future preventive interventions. 30 healthy high performance junior elite athletes competing at national and international level were included. All subjects participate in high intensive sports-specific training for a minimum of 2 years. The subgroups were composed of 16 male volleyball players and 14 (9 male, 5 female) javelin throwers. The mean age of the volleyball and the javelin group was 16.8 (±1.0) and 18.7 (±2.3) years, respectively. No major trauma or surgery of the both shoulders were detected in medical history of the athlets. All subjects underwent questionnaire-based interviews, comprehensive clinical examination of both shoulders, and shoulder scoring systems (ASES, Rowe Score). A special attention was paid to the passive glenohumeral (gh) internal and external rotation in 90° abduction. Bilateral shoulder imaging data were performed using a 3T-MRI (Verio, Siemens Medical Solutions, Erlangen, Germany). The native imaging protocol included T1w coronal, T2w sagittal, T2w DESS 3D axial, PDw axial, and coronal sequences using a dedicated shoulder coil in supine position with the arm positioned in neutral position. Clinical evaluation demonstrated any specific shoulder pathology and all subjects had excellent results regarding ASES (95.2 ±8.6) and Rowe score (96.8 ±6.6). A glenohumeral internal rotation deficit (GIRD) of 16.9° (±11.1°) was proven for the volleyball players and 13.2° (±9.5°) for the javelin athletes. The corresponding external rotation increase measured 16.2° (±10.5°) in the dominant shoulders of the volleyball players versus 11.1° (±9.6°) in the javelin athletes. MRI revealed bony cysts at the insertion area of the footprint of the rotator cuff in 71.5 % of the dominant shoulders of the javelin athletes in comparison of only 12.6 % in the no-dominant shoulder. In contrast, only 14.3 % of the volleyball players showed these cyst formations in their dominant and 6.3 % in their non-dominant shoulders. No rotator cuff lesions and no major chondral damage were seen. Although all athletes had no history of prior shoulder pathology, a high percentage of healthy and asymptomatic junior elite athletes already demonstrate structural changes in their dominant shoulders. This is most commonly known for adult overhead athletes. In addition the results indicate a high prevalence of GIRD in both subgroups of junior elite athletes. However a more intense occurrence was seen in the volleyball subgroup, which may be due to the different, more “hitting type” mechanism specific for volleyball. MRI evaluation showed osseous signs of overload especially in the group of javelin athletes. This may be caused by repetitive microtrauma due to heavy eccentric load. Therefore preventive strategies in young athletes may focus on specific stretching to prevent massive rotational deficits and balanced strength training for adequate muscular function specifically for each overhead sports. A individually combined prevention training is successfully applied in the daily training process and currently under evaluation on a prospective basis.