Virginia Research Day 2022

Medical Resident Research Case Reports

13 Pop, (No Lock), And Drop It. Shoulder Instability In A Division-1 Women’s Soccer Athlete

Brian Lauer, DO; Daniel Califano, OMS II; Emily Whitaker, ATC, LAT, Greg Beato, DO, CAQSM; Mark Rogers, DO, CAQSM, FAAFP, FAOASM, Chris Catterson, MD Corresponding author: blauer@vcom.vt.edu

Introduction: Glenohumeral instability is a common condition affecting the athletic and general population. Posterior instability is often misdiagnosed and overshadowed due to its far more infrequent prevalence and insidious onset compared to anterior dislocations. Initial conservative management is often successful, but with recurrent instability management becomes challenging and requires an individualized approach. This case illustrates multiple management dilemmas in a D1 athlete including recurrent dislocations, recurrence post-surgical correction, bony glenoid loss, and underlying ligamentous laxity. Case Presentation: We present a case of a 19 y/o female, D1 college soccer player with PMHx right posterior shoulder instability s/p labral tear repair and capsulorrhaphy in 2019, as well as left shoulder anterior and posterior capsulorrhaphy in 2020. Patient was competing in soccer match when challenged for the ball on her right side. Patient fell forward on the ground with right arm caught in an abducted and internally rotated position behind her head. She was immediately in pain and came to sideline for evaluation. Injury was steps from VCOM Virginia Virginia Tech Primary Care Sports Medicine Fellowship

humeral head is severely subluxed/dislocated, resting posterior inferior along the posterior glenoid. Supraspinatus attachment intact but distended away from the fluid-filled and distorted joint space. The anterior and posterior labrum are torn. Discussion: This case represents the complexity of posterior shoulder instability. Although less frequent, and often responding to conservative measures, it is a reminder care must be tailored to maximize immediate performance but protect long term function.

the sideline and during presentation shoulder was inferior with dimpling over anterior shoulder and patient holding arm at her side. Traction and slight external rotation was applied with shoulder translating superiorly resulting in improvement in pain and resolution of anterior dimpling. She was subsequently removed from the game, placed in sling, xrays obtained, and follow up scheduled. Following day in clinic patient noted with visible anterior dimpling of right shoulder, which she was able to reduce spontaneously. No bony tenderness to palpation across shoulder girdle, scapula, clavicle and SC joint. Sensation intact to light touch. Intrinsic hands, wrist flexors and extensors 5/5. Biceps, triceps and deltoid difficult to assess but able to hold against gravity. Anterior load and shift with increased translation and feeling of reduction of posterior subluxed shoulder. Positive sulcus sign. Very apprehensive. Rotator cuff testing not performed secondary to pain. Beighton scale score 9/9. Xray showed postsurgical changes of prior glenoid labral repair. Inferior subluxation of the humeral head in relation to the glenoid which may represent joint laxity. No frank shoulder dislocation identified. MRI obtained and showed dysplastic glenoid with a

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