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Incomplete joint side tear of the subscapularis tendon with a small fragment in an adolescent tennis player: a case report.

Kato S, Funasaki H, Kan I, Yoshida M, Kasama K, Marumo K - Sports Med Arthrosc Rehabil Ther Technol (2012)

Bottom Line: He was subsequently diagnosed with incomplete joint side tear of the subscapularis tendon with a small bony fragment.Subsequently, we performed arthroscopic excision of the bony fragment and repair of the subscapularis tendon.This case highlighted the presence of an injury with minor trauma associated with repeated tennis strokes in a skeletally immature patient.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Orthopaedic Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan. soki@jikei.ac.jp.

ABSTRACT

Case: In this case report, we presented the case of an adolescent tennis player with avulsion injury of the subscapularis tendon of the right shoulder.

Patients: A 17-year-old right-hand-dominant male tennis player visited our hospital complaining of pain in the anterior aspect of the right shoulder. We performed X-ray and three-dimensional computed tomography (3D-CT) and magnetic resonance imaging (MRI) scans for the diagnosis.

Results: Plain radiographs did not reveal the presence of lesion; however, 3D-CT and MRI scans showed a small bony fragment located between the humeral head and the glenoid of the scapula and a high-intensity area of the subscapularis tendon. He was subsequently diagnosed with incomplete joint side tear of the subscapularis tendon with a small bony fragment. Subsequently, we performed arthroscopic excision of the bony fragment and repair of the subscapularis tendon.

Conclusions: This case highlighted the presence of an injury with minor trauma associated with repeated tennis strokes in a skeletally immature patient.

No MeSH data available.


Related in: MedlinePlus

A, Arthroscopic view through the posterior portal showing articular-side tear of the subscapularis tendon (c) and a small bony fragment (a) B, When the arm was internally rotated, the small bony fragment was trapped between the humeral head (b) and the scapular glenoid C, Arthroscopic excision of the bony fragment D, Arthroscopic repair of the subscapularis tendon.
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Figure 4: A, Arthroscopic view through the posterior portal showing articular-side tear of the subscapularis tendon (c) and a small bony fragment (a) B, When the arm was internally rotated, the small bony fragment was trapped between the humeral head (b) and the scapular glenoid C, Arthroscopic excision of the bony fragment D, Arthroscopic repair of the subscapularis tendon.

Mentions: In the operating room, the patient was maintained under general anesthesia and placed in the beach-chair position for arthroscopic removal of the fragment. Diagnostic arthroscopy was performed through a standard posterior portal. The articular side of the subscapularis tendon was torn, and an avulsion fracture was identified (Figure4A). We could not confirm the insertion site of the deep surface of the subscapularis tendon as the fracture site, because the area was very small and covered with fibrocartilage. However, the small bony fragment was originally inserted in the deep surface of the subscapularis tendon. Subsequently, internal rotation of the arm resulted in entrapment of the small bony fragment between the humeral head and the glenoid of the scapula (Figure4B). The bony fragment was oval and approximately 7 mm in the major axis. The long head of the biceps showed no signs of subluxation or dislocation. No further intra-articular pathological features were detected. After the anterior and anterosuperior portals were established, the small bony fragment was removed (Figure4C). A Fastin RC suture anchor with a no. 2 Ethibond suture (Mitek, USA) was used and inserted on the side of the fracture via the anterior portal. The 2 threads protruding from the area where the anchor was inserted were introduced through the only deep surface of the subscapularis tendon by the suture relay technique. A mattress suture was then used to repair the subscapularis tendon (Figure4D). Histological examination of the lesion showed that the avulsed bone fragment was surrounded by fibrocartilage (Figure5).


Incomplete joint side tear of the subscapularis tendon with a small fragment in an adolescent tennis player: a case report.

Kato S, Funasaki H, Kan I, Yoshida M, Kasama K, Marumo K - Sports Med Arthrosc Rehabil Ther Technol (2012)

A, Arthroscopic view through the posterior portal showing articular-side tear of the subscapularis tendon (c) and a small bony fragment (a) B, When the arm was internally rotated, the small bony fragment was trapped between the humeral head (b) and the scapular glenoid C, Arthroscopic excision of the bony fragment D, Arthroscopic repair of the subscapularis tendon.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3475128&req=5

Figure 4: A, Arthroscopic view through the posterior portal showing articular-side tear of the subscapularis tendon (c) and a small bony fragment (a) B, When the arm was internally rotated, the small bony fragment was trapped between the humeral head (b) and the scapular glenoid C, Arthroscopic excision of the bony fragment D, Arthroscopic repair of the subscapularis tendon.
Mentions: In the operating room, the patient was maintained under general anesthesia and placed in the beach-chair position for arthroscopic removal of the fragment. Diagnostic arthroscopy was performed through a standard posterior portal. The articular side of the subscapularis tendon was torn, and an avulsion fracture was identified (Figure4A). We could not confirm the insertion site of the deep surface of the subscapularis tendon as the fracture site, because the area was very small and covered with fibrocartilage. However, the small bony fragment was originally inserted in the deep surface of the subscapularis tendon. Subsequently, internal rotation of the arm resulted in entrapment of the small bony fragment between the humeral head and the glenoid of the scapula (Figure4B). The bony fragment was oval and approximately 7 mm in the major axis. The long head of the biceps showed no signs of subluxation or dislocation. No further intra-articular pathological features were detected. After the anterior and anterosuperior portals were established, the small bony fragment was removed (Figure4C). A Fastin RC suture anchor with a no. 2 Ethibond suture (Mitek, USA) was used and inserted on the side of the fracture via the anterior portal. The 2 threads protruding from the area where the anchor was inserted were introduced through the only deep surface of the subscapularis tendon by the suture relay technique. A mattress suture was then used to repair the subscapularis tendon (Figure4D). Histological examination of the lesion showed that the avulsed bone fragment was surrounded by fibrocartilage (Figure5).

Bottom Line: He was subsequently diagnosed with incomplete joint side tear of the subscapularis tendon with a small bony fragment.Subsequently, we performed arthroscopic excision of the bony fragment and repair of the subscapularis tendon.This case highlighted the presence of an injury with minor trauma associated with repeated tennis strokes in a skeletally immature patient.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Orthopaedic Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan. soki@jikei.ac.jp.

ABSTRACT

Case: In this case report, we presented the case of an adolescent tennis player with avulsion injury of the subscapularis tendon of the right shoulder.

Patients: A 17-year-old right-hand-dominant male tennis player visited our hospital complaining of pain in the anterior aspect of the right shoulder. We performed X-ray and three-dimensional computed tomography (3D-CT) and magnetic resonance imaging (MRI) scans for the diagnosis.

Results: Plain radiographs did not reveal the presence of lesion; however, 3D-CT and MRI scans showed a small bony fragment located between the humeral head and the glenoid of the scapula and a high-intensity area of the subscapularis tendon. He was subsequently diagnosed with incomplete joint side tear of the subscapularis tendon with a small bony fragment. Subsequently, we performed arthroscopic excision of the bony fragment and repair of the subscapularis tendon.

Conclusions: This case highlighted the presence of an injury with minor trauma associated with repeated tennis strokes in a skeletally immature patient.

No MeSH data available.


Related in: MedlinePlus