Shoulder Injury in Rock Climbing - poster presentation

Medicine & Science in Sports & Exercise: May 2005 - Volume 37 - Issue 5 - p S457 G-39: Clinical Case Slide - Shoulder Injuries II: SATURDAY, JUNE 4, 2005 10:45 AM - 12:05 PM ROOM: Presidential Chamber B Shoulder Injury - Rock Climbing: 2371 11:25 AM - 11:45 AM Dietrich, Christopher

HISTORY
41 year-old rock climber with two-year history of left shoulder pain. He had no significant history of traumatic injury to his back or shoulders. He had a minimal amount of deep achy pain located posteriorly within the shoulder that occurred during climbing and significant achy pain the day after climbing. This pain would last for a couple of days and then subside. His symptoms were exacerbated by extreme reaching or holding maneuvers during rock climbing and were associated with a sense of posterior instability. Over last two years symptoms progressively worsened and now also involve the contralateral side. There was no upper extremity weakness or radiating radicular pain. There was no numbness or tingling or paresthesias into either upper extremity.

PHYSICAL EXAMINATION
-No subacromial or bony tenderness to palpation
-Examination revealed subjective tightness with shoulder abduction, felt posteriorly
-External rotation 65 degrees right, 75 degrees left
-Normal strength (supraspinatus, int/ext rotation) without pain
-Normal reflexes
-Normal sensation
-Negative Neer's, Hawkins, Speeds bilaterally
-Negative anterior & posterior apprehension bilaterally
-Positive Obrien's and dynamic labral sheer test bilaterally

DIFFERENTIAL DIAGNOSIS
1. Rotator cuff tear/tendonopathy
2. Superior Labral Anterior Posterior (SLAP) lesion
3. Bankhart lesion
4. Glenohumeral Arthritis
5. Posterior impingement

TEST AND RESULTS
- X-Rays Bilateral Shoulders:
- Minimal degenerative sclerosis involving the greater humeral tuberosity
in bilateral shoulders.
- MRI left shoulder:
- Labral tear involving superior, anterior, and inferior aspects sparing from 7 o'clock to 10 o'clock, SLAP VII tear
- Extension of tear into middle glenohumeral ligament
- Slight DJD in acromioclavicular joint
- Normal rotator cuff and biceps tendon
- MRI right shoulder -
- Extensive circumferential tear involving glenoid labrum.
- Paralabral cyst 8 at the o'clock position.
- Signal change within subscapularis tendon.

FINAL WORKING DIAGNOSIS
1. Bilateral SLAP lesions
- SLAP VII on left
- SLAP IX on right
2. Right Rotator Cuff Tendonitis

TREATMENT AND OUTCOMES
1. Physical therapy - rotator cuff strengthening, scapular stabilization
2. Patient deferred surgical repair
3. Continues to participate in Rock Climbing