Topics in Sports MedicineShoulder Internal Derangement and Osteoarthritis in a 25-Year-Old Female Softball Athlete
Introduction
Internal derangement (eg, rotator cuff tears, tendinopathy, and labral tears) and osteoarthritis (OA) are not pathologies typically associated with a young healthy athlete, but the occurrence of shoulder injuries or instability in overhead-throwing sports, such as baseball, softball, volleyball, tennis, or football, is increasingly prevalent.1, 2, 3, 4, 5, 6 The rotator cuff and other muscles are dynamic stabilizers, whereas the glenoid labrum, glenohumeral ligaments, joint capsule, and osseous structures are the static stabilizers of the glenohumeral joint.7 Diagnosis of rotator, labral, or osseous pathologies of the shoulder can be obtained with a variety of imaging modalities, but which structures are best seen, by which modality, has been a topic of ongoing controversy.8, 9, 10, 11, 12, 13, 14 To our knowledge, there have been no case reports demonstrating OA and internal derangement to this severity in a young female softball athlete. Therefore, the purpose of this report is to describe chiropractic management and the diagnostic imaging findings of OA and internal derangement of the shoulder in a collegiate softball player.
Section snippets
Case Report
A 25-year-old woman presented at her initial visit with a variety of complaints including chronic right shoulder pain. Her shoulder pain began in high school insidiously related to softball and working out. She played short stop on her high school and college softball teams. In 2005, she had a labrum reattachment on her right shoulder. Following surgery, she underwent 9 months of physical therapy. In 2009, she reinjured her labrum but did not have reparative surgery. She had 5 intraarticular
Discussion
Shoulder injury and instability are common in the overhead-throwing athlete because of chronic and repetitive overuse. These injuries are usually seen in baseball and softball players instead of impact trauma-related injury seen in football players.6 Most research has been conducted evaluating shoulder injury patterns and biomechanics of baseball pitchers.2, 4 The biomechanics of throwing is divided into 6 stages: the windup, stride phase, cocking phase, acceleration, deceleration, and
Conclusion
Shoulder internal derangement and OA may occur in young overhead-throwing athletes. Clinicians need to be cognizant of the comparable sensitivities and specificities of the imaging modalities used for making these diagnoses, specifically MRI, MRA, and musculoskeletal US. Following a timely diagnosis, the young patient in this case had a good recovery with multimodal chiropractic care.
Funding Sources and Potential Conflicts of Interest
No funding sources or conflicts of interest were reported for this study.
Acknowledgments
The authors thank Andrea Fritz for assistance with this case.
References (15)
- et al.
Osteoarthritis following shoulder instability
Clin Sports Med
(2005) - et al.
Injury patterns and biomechanics of the athlete’s shoulder
Clin Sports Med
(2008) - et al.
Early glenohumeral arthritis in the competing athlete
Clin Sports Med
(2008) - et al.
Diagnostic value of US, MR, and MR arthrography in shoulder instability
Injury
(2013) - et al.
Long-term health outcomes of youth sports injuries
Br J Sports Med
(2010) - et al.
Dominant-limb range-of-motion and humeral-retrotorsion adaptation in collegiate baseball and softball position players
J Athl Train
(2014) - et al.
Surgical repair and rehabilitation of a combined 330° capsulolabral lesion and partial-thickness rotator cuff tear in a professional quarterback: a case report
J Orthop Sports Phys Ther
(2013)
Cited by (2)
A review of hands-on based conservative treatments on pain in recreational and elite athletes
2019, Science and SportsCitation Excerpt :Manual therapy consisted of circular movements followed by compression techniques. Several case reports suggest the use of chiropractic in the management of musculoskeletal pain in a junior hockey player [108], shoulder pain in a softball athlete [109], pain due to a sudden, non-traumatic, ballistic movement of the cervical spine during a Teakwondo competition [110], or thoracic pain in a collegiate runner [111]. A recent systematic review showed the efficacy of manual joint mobilization on pain relief and functional improvement of acute lateral ankle sprains, without specifically referring to sports-related sprains [112].
Nonarthroplasty Options for the Athlete or Active Individual with Shoulder Osteoarthritis
2018, Clinics in Sports MedicineCitation Excerpt :Physical therapy programs have proven to be an effective treatment of other disease processes and, although the consensus remains inconclusive due to a paucity of data, have begun to demonstrate promise for its application in GHJ OA in younger patients. Therapist-directed exercise regimens, manual therapy, manipulations, and a combination of manual therapy and tailored exercise regimens have been shown to decrease pain and improve function for other shoulder disorders.6–11 Furthermore, recent studies have demonstrated that individualized home therapy with patient adherence to rehabilitation protocols have been effective in treating the pain associated with glenohumeral arthritis.12