Posterior Glenoid Dysplasia as a Secondary Finding to Labrum Tear and Subscapularis Strain: A Case Study

Abstract

The purpose of this disablement model case study was to describe the case of a collegiate baseball pitcher suffering from a SLAP lesion and supraspinatus strain that may have been the result of posterior glenoid dysplasia. Despite gross instability and glenohumeral external rotation weakness, the patient was initially able to continue to pitch. While posterior glenoid dysplasia has been described in literature, there have not been studies that have evaluated soft tissue changes that may be associated with this bony morphology abnormality. In this case, the patient reported to the athletic training staff complaining of pain, tightness, and a “clunking” sensation in and around his glenohumeral joint. The patient reported right shoulder pain being worse following pitching, but not experiencing symptoms during the act of pitching. The patient was initially treated with cupping, and therapeutic exercise, and was able to continue pitching. As the season progressed, the patient reported needing increasingly longer time to recover from pitching outings. The patient continued to present with a positive O’Brien’s test, weakness with internal and external rotation, and visible scapular protraction at rest. Upon referral to the team physician, x-rays were ordered to evaluate for bony pathology. The patient was diagnosed with posterior glenoid dysplasia and referred for MRI arthrogram. This imaging revealed a labrum tear and subscapularis strain. The patient was referred for surgery, at which time a labrum and subscapularis debridement, and subacromial bursectomy were performed. The patient was then instructed to follow up with the athletic training staff to initiate therapeutic exercise as prescribed by the attending surgeon. When evaluating glenohumeral weakness and instability, the clinician must consider bony abnormality as a potential factor. If initial treatment attempts do not result in improvements, the clinician must exhaust all diagnostic options to determine the exact nature of the offending pathology.