Posterior Labral Injury in Contact Athletes

Abstract

Nine athletes (seven football offensive linemen, one defensive lineman, and one lacrosse player) were found at arthroscopy to have posterior labral detachment from the glenoid. In our series, this lesion is specific to contact athletes who engage their opponents with arms in front of the body. All patients had pain with bench pressing and while participating in their sport, diminishing their ability to play effectively. Conservative measures were ineffective in relieving their symptoms. Examination under anesthesia revealed symmetric glenohumeral translation bilaterally, without evidence of posterior instability. Treatment consisted of glenoid rim abradement and posterior labral repair with a bioabsorbable tack. All patients returned to complete at least one full season of contact sports and weightlifting without pain (minimum follow-up, > or = 2 years). Although many injuries leading to subluxation of the glenohumeral joint occur when an unanticipated force is applied, contact athletes ready their shoulder muscles in anticipation of impact with opponents. This leads to a compressive force at the glenohumeral joint. We hypothesize that, in combination with a posteriorly directed force at impact, the resultant vector is a shearing force to the posterior labrum and articular surface. Repeated exposure leads to posterior labral detachment without capsular injury. Posterior labral reattachment provides consistently good results, allowing the athlete to return to competition.

Posterior shoulder instability in the athletic population: Variations in assessment, clinical outcomes, and return to sport

“…Primary mechanisms of injury may include: (1) an acute traumatic posteriorly directed shearing force along the glenoid face between the posterior labrum and glenoid articular surface, resulting in capsulolabral deta chment [13] ; (2) repetitive microtrauma to the posterior capsule, ultimately leading to capsular attenuation and labral tears [4] ; or (3) insidious onset of laxity of the posterior capsule and associated passive stabilizers [57] . Other causes of posterior instability often result from (1) excessive glenoid or humeral retroversion; (2) an engaging reverse HillSachs lesion; and (3) and glenoid hyperplasia [1,5] .…”

‘Batter’s Shoulder’: Can Athletes Return to Play at the Same Level After Operative Treatment?

“…The role of posterior shoulder instability as a cause of disability in the athletic population has become increasingly recognized [5,12,15].…”

“…Posterior instability in the athletic population more commonly arises from contact sports such as football and rugby and occurs from acute trauma [12,15] or repetitive microtrauma [20]. In the case of batter's shoulder, the major rotational forces about the shoulder are believed to be the cause of the instability [19].…”

Nonoperative rehabilitation for traumatic and atraumatic glenohumeral instability

“…This is especially true in linemen. Mair et al 26 reported on nine athletes with posterior instability in which eight of nine were linemen and seven were offensive linemen. Often, these patients require surgery as Mair et al 26 also reported 75% required surgical stabilization.…”