Topics in Sports Medicine
Shoulder Internal Derangement and Osteoarthritis in a 25-Year-Old Female Softball Athlete

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Abstract

Objective

The purpose of this report is to describe osteoarthritis and internal derangement of the shoulder in a collegiate softball player.

Clinical Features

A 25-year-old female softball athlete presented with a history of chronic right shoulder pain. A thorough clinical examination and multiple imaging studies were performed. Osteoarthritis was demonstrated on radiographs, and ligamentous and rotator cuff tendon tears were displayed on magnetic resonance imaging. The patient’s treatment plan included full spine manipulation, cold laser therapy, kinesiotaping, stretching, and neuromuscular reeducation of the right shoulder.

Interventions and Outcomes

The patient reported a decrease in symptoms after 1 month, although treatment was sporadic because of poor patient compliance.

Conclusion

Osteoarthritis and internal derangement may occur in overhead-throwing athletes, and correct imaging is needed for timely and accurate diagnoses. Following a timely diagnosis, the young patient in this case had a good recovery with multimodal chiropractic care.

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)

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