Teres Major Avulsion in a Division I Collegiate Baseball Pitcher

Abstract

HISTORY: A 21 year old right handed Division I collegiate baseball pitcher who presents with a 3 week history of right shoulder pain. The student athlete describes his pain as being located posteriorly and most bothersome during the early and late cocking phases of his throwing motion. He describes the pain at these points in his throwing motion as being sharper than his baseline pain. He denies acute injury or any previous injury to this shoulder. He denies pain through the acceleration and follow through phases of his throwing motion. He denies losing any speed off of his fastball. Initially, he took a week off to do rehabilitation with his ATC. He did note improvement, but subsequently developed pain when he returned to throwing. PHYSICAL EXAMINATION: Examination of the right shoulder was notable for tenderness to palpation posteriorly and inferiorly in the shoulder joint. There was full active range of motion of his shoulder and he had 5/5 strength in all directions. O'brien's test was positive for pain and weakness. There was no scapular dyskinesia on exam. DIFFERENTIAL DIAGNOSIS: SLAP lesion Rotator cuff tendinosis Rotator cuff tear Teres Major Avulsion Suprascapular nerve impingement Thoracic Outlet syndrome TEST AND RESULTS: X-rays: possible inferior bony abnormality on labrum MRI: 1) Avulsion of the teres major from its humeral attachment. 2) Chronic changes in posterior glenoid labrum with small perforation and associated 8 mm paralabral cyst. FINAL WORKING DIAGNOSIS: Right Teres Major Avulsion TREATMENT AND OUTCOMES: The student athlete began a course of physical therapy under the supervision of his ATC. Treatment included rotator cuff strengthening, scapular stabilization, and latissimus dorsi strengthening. He was restricted from throwing, but permitted to hit as long as he remained pain free. He was able to return to throwing activity approximately 2 months following the injury.