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Approach to Latissimus Dorsi and Teres Minor Injuries in the Baseball Pitcher

  • Injuries in Overhead Athletes (J Dines and C Camp, section editors)
  • Published:
Current Reviews in Musculoskeletal Medicine Aims and scope Submit manuscript

Abstract

Purpose of Review

Tears of the latissimus dorsi and teres major are uncommon but significant injuries, most frequently seen in high-level, overhead throwing athletes. Diagnosis can be challenging, as there are no pathognomonic signs, symptoms, or physical exam findings associated with latissimus dorsi/teres major tears, and the clinician must have a high suspicion for this injury. While many of these tears can be treated non-operatively, a subset of these benefits from surgical intervention. Rehabilitation following operative and non-operative treatments of these injuries is extensive, and timing of return to sport can be variable from 3 to 12 months.

Recent Findings

The literature surrounding latissimus dorsi/teres major injuries is sparse. Several small studies have shown good results in patients with mild to moderate tears that were treated non-operatively. Recent evidence has shown good results following operative repair of larger tears, with excellent return to sport rates. Furthermore, focused rehabilitation is imperative when treating patients with latissimus dorsi/teres major injuries to allow these athletes to return to sport.

Summary

Latissimus dorsi/teres major tears are uncommon but significant injuries in the throwing athlete. Prompt diagnosis, proper treatment, and focused rehabilitation will allow these patients to return to sport in a safe and efficient manner.

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References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Erickson BJ, Gupta AK, Harris JD, Bush-Joseph C, Bach BR, Abrams GD, et al. Rate of return to pitching and performance after Tommy John surgery in Major League Baseball pitchers. Am J Sports Med. 2013.

  2. •• Camp CL, Zajac JM, Pearson DB, Sinatro AM, Spiker AM, Werner BC, et al. Decreased shoulder external rotation and flexion are greater predictors of injury than internal rotation deficits: analysis of 132 pitcher-seasons in professional baseball. Arthroscopy. 2017;33(9):1629–36 This study added to the current knowledge surrounding shoulder and elbow injuries in professional baseball players. The authors found that the overall loss of shoulder flexion and the loss of shoulder external rotation were significant predictors of injury in these high-level athletes.

    Article  Google Scholar 

  3. Conte SA, Fleisig GS, Dines JS, Wilk KE, Aune KT, Patterson-Flynn N, et al. Prevalence of ulnar collateral ligament surgery in professional baseball players. Am J Sports Med. 2015;43(7):1764–9.

    Article  Google Scholar 

  4. Conte S, Camp CL, Dines JS. Injury trends in Major League Baseball over 18 seasons: 1998-2015. Am J Orthop. 2016;45(3):116–23.

    PubMed  Google Scholar 

  5. Dines JS, Williams PN, ElAttrache N, Conte S, Tomczyk T, Osbahr DC, et al. Platelet-rich plasma can be used to successfully treat elbow ulnar collateral ligament insufficiency in high-level throwers. Am J Orthop. 2016;45(5):296–300.

    PubMed  Google Scholar 

  6. Dines JS, Jones K, Maher P, Altchek D. Arthroscopic management of full-thickness rotator cuff tears in Major League Baseball pitchers: the lateralized footprint repair technique. Am J Orthop. 2016;45(3):128–33.

    PubMed  Google Scholar 

  7. Camp CL, Conte S, D'Angelo J, Fealy SA, Ahmad CS. Effect of predraft ulnar collateral ligament reconstruction on future performance in professional baseball: a matched cohort comparison. Am J Sports Med. 2018;363546518758298.

  8. Chalmers PN, Erickson BJ, Verma NN, D'Angelo J, Romeo AA. Incidence and return to play after biceps tenodesis in professional baseball players. Arthroscopy. 2017.

  9. Erickson BJ, Romeo AA. The ulnar collateral ligament injury: evaluation and treatment. J Bone Joint Surg Am. 2017;99(1):76–86.

    Article  Google Scholar 

  10. Erickson BJ, Harris JD, Fillingham YA, Cvetanovich GL, Bush-Joseph CA, Bach BR Jr, et al. Treatment of ulnar collateral ligament injuries and superior labral tears by Major League Baseball team physicians. Arthroscopy. 2016;32:1271–6.

    Article  Google Scholar 

  11. •• Erickson BJ, Chalmers PN, Waterman BR, Griffin JW, Romeo AA. Performance and return to sport in elite baseball players and recreational athletes following repair of the latissimus dorsi and teres major. J Shoulder Elbow Surg. 2017. This is the largest series of latissimus dorsi/teres major injuries that were treated oepratively. The authors found excellent clinical outcomes and return to sport rates following operative repair.

  12. Schickendantz MS, Kaar SG, Meister K, Lund P, Beverley L. Latissimus dorsi and teres major tears in professional baseball pitchers: a case series. Am J Sports Med. 2009;37(10):2016–20.

    Article  Google Scholar 

  13. Nagda SH, Cohen SB, Noonan TJ, Raasch WG, Ciccotti MG, Yocum LA. Management and outcomes of latissimus dorsi and teres major injuries in professional baseball pitchers. Am J Sports Med. 2011;39(10):2181–6.

    Article  Google Scholar 

  14. Ellman MB, Yanke A, Juhan T, Verma NN, Nicholson GP, Bush-Joseph C, et al. Open repair of an acute latissimus tendon avulsion in a Major League Baseball pitcher. J Shoulder Elbow Surg. 2013;22(7):e19–23.

    Article  Google Scholar 

  15. Hapa O, Wijdicks CA, LaPrade RF, Braman JP. Out of the ring and into a sling: acute latissimus dorsi avulsion in a professional wrestler: a case report and review of the literature. Knee Surg Sports Traumatol Arthrosc. 2008;16(12):1146–50.

    Article  Google Scholar 

  16. Hiemstra LA, Butterwick D, Cooke M, Walker RE. Surgical management of latissimus dorsi rupture in a steer wrestler. Clin J Sport Med. 2007;17(4):316–8.

    Article  Google Scholar 

  17. Park JY, Lhee SH, Keum JS. Rupture of latissimus dorsi muscle in a tennis player. Orthopedics. 2008;31(10).

  18. Pearle AD, Kelly BT, Voos JE, Chehab EL, Warren RF. Surgical technique and anatomic study of latissimus dorsi and teres major transfers. J Bone Joint Surg Am. 2006;88(7):1524–31.

    Article  Google Scholar 

  19. Pouliart N, Gagey O. Significance of the latissimus dorsi for shoulder instability. I. Variations in its anatomy around the humerus and scapula. Clin Anat. 2005;18(7):493–9.

    Article  CAS  Google Scholar 

  20. Pearle AD, Voos JE, Kelly BT, Chehab EL, Warren RF. Surgical technique and anatomic study of latissimus dorsi and teres major transfers. Surgical technique. J Bone Joint Surg Am. 2007;89(Suppl 2 Pt.2):284–96.

    Article  Google Scholar 

  21. Beck PA, Hoffer MM. Latissimus dorsi and teres major tendons: separate or conjoint tendons? J Pediatr Orthop. 1989;9(3):308–9.

    Article  CAS  Google Scholar 

  22. Jobe FW, Moynes DR, Tibone JE, Perry J. An EMG analysis of the shoulder in pitching. A second report. Am J Sports Med. 1984;12(3):218–20.

    Article  CAS  Google Scholar 

  23. Jobe FW, Tibone JE, Perry J, Moynes D. An EMG analysis of the shoulder in throwing and pitching. A preliminary report. Am J Sports Med. 1983;11(1):3–5.

    Article  CAS  Google Scholar 

  24. Camp CL, Zajac JM, Pearson D, Wang D, Sinatro AS, Ranawat AS, et al. The impact of workload on the evolution of hip internal and external rotation in professional baseball players over the course of the season. Orthop J Sports Med. 2018;6(2):2325967117752105.

    Article  Google Scholar 

  25. Wilk KE, Macrina LC, Fleisig GS, Aune KT, Porterfield RA, Harker P, et al. Deficits in glenohumeral passive range of motion increase risk of shoulder injury in professional baseball pitchers: a prospective study. Am J Sports Med. 2015;43(10):2379–85.

    Article  Google Scholar 

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Correspondence to Brandon J. Erickson.

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Conflict of Interest

Brandon J. Erickson and Nina Petronico declare no conflict of interest.

Anthony A. Romeo reports grants, personal fees, and non-financial support from Arthrex, non-financial support from AANA, has completed research work for Aesculap/B. Braun, Histogenics, Medipost, NuTech, OrthoSpace, Smith & Nephew, and Zimmer, and personal fees from Saunders/Mosby-Elsevier and SLACK Incorporated.

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This article is part of the Topical Collection on Injuries in Overhead Athletes

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Erickson, B.J., Petronico, N. & Romeo, A.A. Approach to Latissimus Dorsi and Teres Minor Injuries in the Baseball Pitcher. Curr Rev Musculoskelet Med 12, 24–29 (2019). https://doi.org/10.1007/s12178-019-09532-y

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