2015 ISAKOS Biennial Congress ePoster #2301

Asymptomatic Magnetic Resonance Imaging Pathology In Overhead Athletes

Nicole H. Goldhaber, MA, BA, Burbank, CA UNITED STATES
Christopher S. Lee, MD, MBA, Burbank, CA UNITED STATES
Shane Michael Davis, MD, Orange, CA UNITED STATES
William B Stetson, MD, Burbank, CA UNITED STATES
Stetson Powell Orthopedics and Sports Medicine, Burbank, CA, USA

FDA Status Not Applicable

Summary: We investigated the predictive value of MRI findings from dominant shoulders of asymptomatic elite overhead athletes with the overarching goal of preventing unnecessary surgeries.

Abstract:

Introduction

Elite overhead athletes, such as volleyball players, are predisposed to shoulder injuries. This is likely due to repetitive overhead movement and overloading of the shoulder joint and surrounding muscles and ligaments, including the rotator cuff and the glenoid labrum. These athletes adapt with increased external rotation of their dominant “hitting” shoulder which leads to repetitive twisting and internal impingement of these structures. Magnetic resonance imaging (MRI) is an effective tool for investigating the presence of rotator cuff and labral injuries. We hypothesized that MRIs of elite volleyball players’ dominant shoulders would indicate extensive asymptomatic shoulder pathology which does not prevent the athlete from competing at a national level at this time. To test this hypothesis, the objective of this study was to evaluate the history, physical examination, and MRI findings of elite overhead athletes and to determine the incidence of asymptomatic shoulder pathology that they are able to play with. We hope that this knowledge will prevent unnecessary surgical procedures.

Methods

17 asymptomatic elite volleyball players of the United States Men’s and Women’s National Indoor Volleyball Teams underwent MRIs (T 00.2.7) of their dominant shoulder and physical examination of both shoulders at the Burbank office of Stetson Powell Orthopedics and Sports Medicine. Asymptomatic was defined as being able to play volleyball without restrictions. These studies were reviewed by two fellowship-trained musculoskeletal radiologists. The players completed patient history forms regarding prior injury and treatment to their dominant shoulder. Then, visual analog pain scores, range of motion, strength, UCLA shoulder scores and American Shoulder and Elbow Society (ASES) outcome scores were measured and recorded.

Results

The mean age at the time of MRI was 26.00 years (range: 23-30 years). There were 13 male players and four female players. There were 16 right-handed players, and one left-handed player. Thirteen of the athletes had rotator cuff tearing (76%): eight with supraspinatus tearing (47%) (two high-moderate grade and six low grade), one with infraspinatus tearing (6%), and two with subscapularis tearing (12%). Five had tearing of the labrum (29%) and five additional athletes had labral fraying (29%). Eight had degeneration of the capsule (47%), 11 had degeneration of the AC joint (65%), five had degeneration of the glenohumeral joint (29%), and nine had tendonitis or degeneration of the supraspinatus and/or infraspinatus (53%). There were no benign exams.

Discussion

The MRI findings in asymptomatic overhead athletes in this study all contain abnormal pathology. These findings support the notion that repetitive overhead movements likely cause strain on the shoulder joint, particularly the rotator cuff, labrum, and AC joint, causing injury to these structures. However, all of the athletes are asymptomatic and are capable of competing without any restrictions. Therefore, we recommend that operative management on overhead athletes only be utilized following significant non-operative treatment as the symptoms may not be a result of the pathology seen in the MRI.