Shoulder Pain in a Collegiate Tennis Player

Abstract

HISTORY: A 20-year old, left hand dominant, collegiate tennis player presented to his training room for evaluation of left shoulder pain. The shoulder pain had an insidious onset that began while working a summer construction job approximately 2 months prior to presentation. During the summer he had been playing matches and practicing 2–3 hours a day 5–6 days a week. On return to school and tennis playing he had a new racket and increased tension on the strings. He noticed shoulder pain, mostly posterior, during the serve and follow-through. He denied any history of previous shoulder injury or acute event leading up to his current symptoms PHYSICAL EXAM: 20-year old male in no acute distress. Atrophy of the left infraspinatus. Full, pain-free active range of motion. No AC tenderness. Mild tenderness over greater tuberosity of humerus. Pain over greater tuberosity with empty can test. Negative labral, instability or impingement signs. Strength 4-/5 external rotation on left. Remainder of exam normal. DIFFERENTIAL DIAGNOSIS: Suprascapular nerve entrapment Spinoglenoid cyst Suprascapular neuropathy Myopathy TESTS AND RESULTS: Radiology: Plain films – Normal MR I – Atrophy of infra spinatus, Prominent varicosities in suprascapular notch extending medially to a multilobulated cystic abnormality, small area of fibrosis near base of suprascapular notch, tendinosis of infraspinatus and supraspinatus tendons, blunting of posterior labrum, no space occupying lesions in spino-glenoid notch. EMG: Severe, chronic left suprascapular mononeuropathy, single MUAP firing in infraspinatus, 2+ fibrillation potentials in infraspinatus, normal supraspinatus and posterior deltoid FINAL/WORKING DIAGNOSIS: Left suprascapular mononeuropathy restricted to only fibers to infraspinatus TREATMENT AND OUTCOMES: Surgical consult – Conservative treatment recommended Physical therapy – Rotator cuff strengthening and scapular stabilization Active rest for 3 weeks then return to play as tolerated 4. The athlete returned to play after 3 weeks of rest with decreased shoulder pain. Follow-up EMG in 2–3 months