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Throwing-related injuries of the subscapularis in professional baseball players

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Abstract

Objective

To describe the MR appearance of a series of throwing-related injuries to the subscapularis muscle-tendon complex among baseball players.

Materials and methods

A retrospective review of MR scans of the shoulder in players from 1 professional baseball organization over the course of 5 years was performed to identify cases with findings suggestive of subscapularis injury. These findings were graded and the medical record was reviewed to assess clinical findings, treatment, and follow-up. Preinjury baseline measurements of arm external rotation at 90° of abduction were compared to measurements from a noninjured cohort to evaluate whether this measure is a risk factor for injury.

Results

A total of 133 MR scans of the shoulder were evaluated. Eleven of the scans demonstrated signal changes suggesting subscapularis injury; 10 of these 11 patients had clinical findings supporting a diagnosis of throwing-related subscapularis strain. There were four grade 1, four grade 2, and two grade 3 injuries. All injuries occurred in the inferior half of the subscapularis at the myotendinous junction. Risk of subscapularis injury increased with lower levels of dominant arm external rotation (odds ratio, 1.12; 95 % CI, 1.07–1.21; p < 0.001). A threshold of dominant arm external rotation of <106° demonstrated sensitivity of 0.700 (95 % CI, 0.392–0.897) and specificity of 0.951 (95 % CI, 0.888–0.982) for subscapularis injury.

Conclusion

Throwing-related subscapularis injuries occur in the inferior half of the muscle at the myotendinous junction. Our data suggest that there is an increased risk of these injuries with lower levels of dominant arm external rotation.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Authors and Affiliations

  1. Imaging Institute, Cleveland Clinic, Cleveland, OH, 44195, USA

    Joshua M. Polster

  2. Center for Shoulder, Elbow and Sports Medicine, Columbia University Medical Center, New York, NY, USA

    T. Sean Lynch

  3. Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA

    Jennifer A. Bullen

  4. Cleveland Indians, Cleveland, OH, USA

    Lonnie Soloff

  5. Imaging Institute, Cleveland Clinic, Cleveland, OH, USA

    Hakan Ilaslan & Naveen Subhas

  6. Orthopedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA

    Mark S. Schickendantz

Authors
  1. Joshua M. Polster
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  2. T. Sean Lynch
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  3. Jennifer A. Bullen
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  4. Lonnie Soloff
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  5. Hakan Ilaslan
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  6. Naveen Subhas
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  7. Mark S. Schickendantz
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Corresponding author

Correspondence to Joshua M. Polster.

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Polster, J.M., Lynch, T.S., Bullen, J.A. et al. Throwing-related injuries of the subscapularis in professional baseball players. Skeletal Radiol 45, 41–47 (2016). https://doi.org/10.1007/s00256-015-2239-9

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  • DOI: https://doi.org/10.1007/s00256-015-2239-9

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