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 The injury, dubbed “acromial apophysiolysis” by the authors, is
characterized by incomplete fusion of the bones that form the top
portion of the shoulder joint, the acromion, and local swelling and
fluid (edema).
“Over the years,” said lead author Dr. Johannes Roedl, the study
team had noticed young baseball players “who came in at the end of
the season with shoulder pain, but with MRI imaging on which we
really didn't see anything besides the abnormality, that edema at
the acromion.”
Roedl, a radiologist in the musculoskeletal division at Thomas
Jefferson University Hospital in Philadelphia, said that neither the
radiologists nor orthopedic surgeons knew if these abnormalities
were clinically relevant, but they knew something was going on, so
they decided to take a closer look at all the cases they had seen.
“We looked at all the clinical data that we had from the orthopedic
surgery department,” Roedl said. “In terms of how did the patients
present, where was the pain, and of course, their history in terms
of sports - what kind of sports did those patients play?”
He said they were surprised at how many patients appeared to have
the condition.
“I mean it's still a relatively rare condition – only about 2.5
percent of patients at the age range between 15 and 25 who come in
with shoulder pain have that acromial apophysiolysis,” he said.
Roedl said it is most likely an overuse injury from too much
pitching because most of the patients who had it were “really avid
pitchers - the majority pitched more than one hundred pitches per
week.”
He and his colleagues reviewed medical records for more than 2,000
patients, both male and female, between the ages of 15 and 25 who
had MRIs for shoulder pain between 1998 and 2012. Most of the
patients were pitchers.
A total of 61 patients had pain at the top of the shoulder and
incomplete fusion of the acromion but no other radiological
findings. The study team compared them to a control group of 61
similar patients who had other identifiable causes for their
shoulder pain.
The researchers found that 40 percent of the patients with acromial
apophysiolysis threw more than 100 pitches per week compared to 8
percent of the control group, they report in the journal Radiology.
One patient underwent surgery and all of the patients rested their
pitching arms for three months and took nonsteroidal
anti-inflammatory (NSAID) medications.
The research team was also able to review follow-up images, either
MRIs or X-rays, for 52 participants after they were 25 years old,
the age when bone development would be complete. The average age at
follow-up was 27 and a half, and the average interval since the
original images was eight years.
Of the 29 patients with apophysiolysis as teens, 25 showed
incomplete bone fusion at the acromion at follow-up, compared to
only one out of the 23 controls.
Torn rotator cuff muscles were also more common - and worse - in the
adult patients who had apophysiolysis than in the control group.
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“You can imagine if the bone in the shoulder doesn't fuse it’s kind
of unstable,” Roedl said. “This is not a medical term, but it's
essentially ‘floating’ and doesn't really have a fixed point.”
Roedl said that when a bone floats around it can press on tendons
and those tendons can rupture or tear.
“And that's what we saw in those patients - that they more often had
tendon tears of the rotator cuff . . . so it actually had a
long-term effect on those patients,” he said.
“Overall, I think it’s a great radiology study. The authors describe
the presentation of a new condition in a fairly large sample of
patients that had previously not been done in that capacity,” Kyle
Aune told Reuters Health in an email.
Aune is a clinical researcher with the American Sports Medicine
Institute in Birmingham, Alabama. He wasn’t involved in the study.
But, Aune isn’t yet convinced the condition is the sole cause of
rotator cuff tears.
“While possible, it is likely that these rotator cuff injuries would
be due to a combination of factors including general overuse and
impingement from biomechanical flaws within a pitcher’s throwing
mechanics,” he said.
Aune also wasn’t sure that female softball pitchers should have been
grouped with male baseball pitchers since the throwing motions are
quite different.
“The majority of the girls in the study played softball – it’s a
different pitching style, but they still have an over the head
movement, and that's probably what causes the problem,” Roedl said.
Roedl added that in the future, they want to look closely at other
sports to see if it’s really just confined to pitching or if it’s
found in other athletes who use overhead motions, such as tennis,
lacrosse or swimming.
As for prevention, he said that not overdoing the same pitching
motion over and over is the key.
“It's important to pitch less than 100 pitches per week when you're
young,” Roedl said. “Take the off-season off, take a break of two or
three months,” he said.
SOURCE: http://bit.ly/1uhaPcZ Radiology, online October 14, 2014.
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