Recommended Citation
Ramos Tuarez O. The price of the pitch: When repetitive stress can cause anatomical developmental abnormalities. Poster presented at: American College of Sports Medicine (ACSM) 2026 Annual Meeting; May 28, 2026; Salt Lake City, UT.
Presentation Notes
Poster presented at: American College of Sports Medicine (ACSM) 2026 Annual Meeting; May 28, 2026; Salt Lake City, UT.
Abstract
CASE HISTORY: 17 yo right-handed softball player presented to training room after a shoulder subluxation during overhead throw at scrimmage. She reported continued popping sensation and pain with overhead throws that did not improve with rest. She was able to continue underhand pitching and hitting with minimal pain. Minimal pain at rest. Started physical therapy but continued pain and feeling of grinding with overhead activities. Denied previous trauma, numbness, tingling or upper extremity weakness.
PHYSICAL EXAM: A0x3. Neck: No tenderness to palpation on the cervical spine, FROM of cervical spine. Negative spurling's. Right shoulder: FROM, Pain at end ROM with flexion and abduction. RC testing aggravated symptoms, O’Briens and Grind test positive, Apprehension test positive for anterior and posterior instability and inferior pain with noted muscle guarding. Strength decreased 4+/5 with resisted ER. Scapular dyskinesia noted without winging. Sensation of dermatomes C5-T8 testing was normal.
DIFFERENTIAL DIAGNOSES: Rotator cuff tendinitis vs tear, Labral tear, Shoulder instability, Bankart lesion.
TESTS & RESULTS: Xray of the right shoulder 4 views: no bony lesion, no malalignment, no fractures. MRI arthrogram right shoulder: Rotator cuff of normal volume, no tears. Glenoid demonstrated posterior glenoid lip with dysplasia as well as mild posterior labrum thickening without osteochondral injury.
FINAL DIAGNOSIS: Shoulder instability due to developmental posterior glenoid dysplasia. Although Posterior glenoid dysplasia prevalence can vary significantly amongst general population there seems to be an increased prevalence in overhead throwing athletes where repetitive stress can contribute to the developmental abnormalities of the glenoid. This in term can lead to significantly reduction in playing time and make management challenging both non operatively and operatively. Shared decision making was made to proceed with non-operative treatment.
OUTCOME OF THE CASE: Patient improved in pain symptoms and frequency of pain with focused physical therapy although continued to experience pain with overhead throwing. It was shared decision making to allow for participation with sports accommodation to avoid overhead throwing.
RETURN TO ACTIVITY AND FURTHER FOLLOW-UP: Patient continues to follow up in training room and will be followed up during the season to monitor symptoms and accommodations.
Type
Poster