Sports Injuries to the Latissimus Dorsi and Teres Major

Abstract

Injuries to the latissimus dorsi and teres major muscles, while rare, are debilitating. They are seen in a variety of sports, although disproportionately in the throwing shoulder of baseball pitchers. There have been 25 case reports and 2 case series published on the nonoperative and operative management of these injuries. Latissimus dorsi and teres major muscle anatomy, function, and common injury patterns are well described in these case reports. Also well detailed are the typical patient presentation, physical examination, and imaging findings. Latissimus dorsi tendon injuries are sometimes treated operatively, whereas latissimus dorsi muscle belly or isolated teres major injuries are treated nonoperatively. Nonoperative treatment includes oral anti-inflammatories and shoulder physical therapy. A number of surgical patient positions, approaches, and fixation constructs have been described, although 2 techniques of positioning and surgical approach are used most commonly. Fixation is most often performed with suture anchors. Return-to-play timing, shoulder strength, and healing on magnetic resonance imaging are variable. No standard of care currently exists for the treatment of latissimus dorsi or teres major injuries. If treating a patient with an injury to either muscle, the clinician should be familiar with accumulated experience as reported in the published literature.

Sonographic appearance of a trapezius muscle tear in a high school pitcher

“…These injuries occur because of the significant eccentric forces, especially during the follow-through/deceleration phases. 5 In our case, this patient threw exceptionally hard for his age, with top velocities over 80 mph. For this patient's age and development, these significant forces are the likely cause of his unique injury.…”

“…Tears and avulsions of the latissimus dorsi and teres major are well described in this population. These injuries occur because of the significant eccentric forces, especially during the follow‐through/deceleration phases 5 . In our case, this patient threw exceptionally hard for his age, with top velocities over 80 mph.…”

Tendon transfers for irreparable rotator cuff tears

“…11 The TM is a small, rectangular muscle originating from the posterior aspect of the inferior angle of the scapula and inserting medial to the LD insertion on the humerus. 12 Its vascular supply is derived from the circumflex scapular artery, a branch of the subscapular artery and its nerve supply is from the lower subscapular nerve, a branch of the posterior cord of the brachial plexus. 8 TM is an adductor and internal rotator.…”

Surgically relevant anatomy of the axillary and radial nerves in relation to the latissimus dorsi tendon in variable shoulder positions: A cadaveric study

“…Tendon repair with suture anchors has been described, highlighting the relevancy of the anatomic relationship of latissimus dorsi tendon to nearby neurologic structures. 15 Numerous studies have contributed to our knowledge of the anatomic course as well as clinical relevance of the axillary and radial nerves with the shoulder. The spatial relationship of the radial nerve to various landmarks about the shoulder has been well studied in the literature, particularly relating to the course of the radial nerve as it traverses the spiral groove on the posterior aspect of the humerus.…”