Right Shoulder Injury-Basketball

Abstract

HISTORY A 20-year old right hand dominant female collegiate basketball player sustained an injury to her right shoulder while reaching forward for the ball during a conference game. Although she is not certain, she believes that she may have had some minor contact with another player at that time. She reported that it felt as if her shoulder was dislocated and she was unable to move it through any considerable range of motion. The trainer at the game placed her arm in external rotation and apparently reduced the shoulder. PHYSICAL EXAMINATION She was evaluated for the complaint of apprehension and inability to return to basketball three days after the injury. The right shoulder examination was significant for abnormal scapulothoracic rhythm with scapular hiking present but nearly full active abduction. Active internal rotation was limited to approximately 20 degrees and active external rotation to approximately 30 degrees. Passively slightly more motion was present but produced significant pain. Strength was graded as 4–5/5 within the available motions, but again produced discomfort. Although apprehension signs were negative, Hawkin's, Neer's, O'Brien's and anterior glide tests were all positive. DIFFERENTIAL DIAGNOSIS Labral tear (Bankart lesion) Supraspinatus impingement vs. strain or tear Infraspinatus impingement vs. strain or tear Biceps strain Hill Sachs lesion Subscapularis impingement vs. strain or tear TEST AND RESULTS Shoulder MRI with and without contrast Disruption of the subscapularis tendon with changes involving the periosteum of the scapula Remaining rotator cuff muscles intact Bankart's and ALPSA lesion with disruption of the anterior-inferior labrum with bone and soft tissue defect Intact humeral head without evidence of bone avulsion or humeral head edema FINAL WORKING DIAGNOSIS: Right subscapularis tear with disruption the scapular periosteum, Bankart's and ALPSA lesions. TREATMENT AND OUTCOMES Acute treatment consisted of ice, NSAIDs and activity modification-choose not to play for the remainder of the season. Initial therapeutic exercise consisted of active and active assisted shoulder range of motion exercises in all planes. Gradually advanced to a progressive rotator cuff strengthening program as full pain-free motion returned. A scapular stabilization exercise program was initiated. Sport specific conditioning, initiated 4 months post injury, consisted of over-head activities in preparation for volleyball season. Outcome: Began playing collegiate volleyball approximately 5 months post injury and will hopefully return to basketball this coming season.