Wrestler's Shoulder

Abstract

History: 14 year old male with left shoulder pain after injury during wrestling meet. He was participating in wrestling meet 2 days prior when he was thrown to the mat. He landed on his left elbow and felt immediate pain in his shoulder, was unable to move the shoulder due to pain. He has decreased range of motion and weakness with shoulder movement, pain with moving, lifting, and sleeping. Denies any radiating pain, numbness/tingling or history of prior shoulder injuries. Physical Examination: No obvious deformity, no bony tenderness to palpation. Active ROM is forward flexion to 140 degrees with pain, abduction to 120 degrees with pain, external rotation with elbow at side to 20 degrees with pain, internal rotation to L3 with pain. Passive ROM full in all directions. The belly-press test, lift-off tests are abnormal, and the bear hug test shows weakness. Strength 4/5 of the infraspinatus, 4/5 of supraspinatus with pain. Neer/Hawkins, Obrien's signs negative. Neurovascularly intact in the bilateral upper extremities. Differential Diagnosis: Humeral, glenoid or scapular fracture, Rotator cuff tear, AC joint dislocation Final/Working Diagnosis: Fracture to base of coracoid process, Avulsion fracture of lesser tuberosity of humerus Tests and Results: Xray L shoulder: Humeral head high-riding. Widening of the left coracoid on axillary view. Widening of the AC joint. Humeral physes open, normal and symmetric compared to contralateral shoulder. MRI L shoulder: Minimally displaced fracture through base of the coracoid process, medially-displaced, lesser tuberosity physeal fracture. Hemarthrosis of the glenohumeral joint. Edema within subscapularis muscle belly. No rotator cuff full-thickness tears. Treatment and Outcomes: Athlete was referred to an Orthopaedic surgeon and underwent lesser tuberosity avulsion repair, coracoid ORIF, and closed treatment of AC joint instability. Patient immobilized in a sling for 6 weeks post-operatively. Passive ROM was initiated at 2 weeks post-operatively. Active ROM was allowed at 6 weeks progressing to full active elevation. Athlete was allowed to begin weight-lifting as tolerated, running and non-contact practice at 8 weeks. Post-operative course was uncomplicated and the athlete was cleared for full return at 12 weeks post-operatively.