POSTERIOR SHOULDER PAIN ??? BASEBALL

Abstract

HISTORY: A 20-year-old Division 1 college baseball pitcher presented with posterior right shoulder pain of 6 month's duration. He is 2 years post UCL reconstruction. He returned to 2–3 innings of pitching 1 year post-op without incident in the fall season. He had two good outings the following spring followed by inability to pitch on the third outing. He has falled multiple attempts at rehabilitative strengthening. He was previously diagnosed with RTC tendonitis. PHYSICAL EXAMINATION: Cervical spine and UE neuro vascular examination is WNL bilateral. ROM is WNL for an overhead athlete with reduced ipsilateral IR. Increased LSS on the right. NIS produces end range pain. HIS produces posterior shoulder pain, DIT is positive Relocation is positive. Full can is 5/5, Empty can is 4/5. ER is 5/5. Sulcus is 2 on right 1 on left. Anterior draw is 2+ with click, posterior draw is 1+ on right, Anterior and posterior draws are 1+ on left. LOT is positive on right negative on left. Obrien's Maneuver positive SLAP lesion. Negative anterior slide test. Negative SLAP-rehension test. DIFFERENTIAL DIAGNOSIS: RTC tendonitis right shoulder Secondary impingment right shoulder Internal glenoid impingement right shoulder SLAP tear right shoulder TEST AND RESULTS: Plain film X-rays – Right shoulder:WNL MRI with contrast – Right shoulder: 1st MRI: signal changes consistent with impact lesion on the greater tuberosity Capsular redundancy 2nd MRI: RTC fraying and posterior labral fraying Capsular redundancy FINAL/WORKING DIAGNOSIS: Right shoulder internal glenoid impingement with RTC and labral fraying Right shoulder acquired MDI-AI TREATMENT: Right shoulder arthroscopic debridement Right shoulder thermal capsular shrinkage