Bilateral Shoulder Pain In A Young Weightlifter

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Bilateral Shoulder Pain In A Young Weightlifter - Page #4

Working Diagnosis: Bilateral Acromial Apophysiolysis Treatment: Patient was advised to rest from any overhead activities for 2-3 months and physical therapy was prescribed. Patient was also instructed to take over-the-counter non-steroidal anti-inflammatories on an as needed basis for pain. Outcome: Patient reported complete resolution of pain after 6-8 weeks of treatment. At 12-week follow up, he was completely asymptomatic and was successfully returned to sports. Author's Comments: Acromial apophysiolysis is characterized as incomplete fusion of the acromial apophyses. It is a rare cause of shoulder pain in patients aged 15-25 years old. It is often bilateral. It is caused by repetitive traction forces from the deltoid on the developing acromion, typically seen in young overhead athletes. It is associated with development of an os acromiale, rotator cuff tear and/or shoulder impingement later in life. The patient typically presents with superior shoulder pain and/or tenderness over the acromion. Shoulder radiographs may show abnormality of the apophysis. MRI will show marrow edema adjacent to the apophysis with irregular margins, while a normal acromion apophysis will have more uniform margins. Treatment is a 2-3 month period of rest, ice, NSAIDs, and cessation of pitching or overhead activities. Editor's Comments: Acromial apophysiolysis has been described as isolated edema at the acromial apophysis on MRI and found to be associated with superior shoulder tenderness in young athletes under the age of 25. It is commonly seen in pitchers, as a known risk factor for the development of acromial apophysiolysis is a pitch count of more than 100 pitches in a week. References: 1. Roedl JB, Morrison WB, Ciccotti MG, Zoga AC. Acromial apophysiolysis: superior shoulder pain and acromial nonfusion in the young throwing athlete. Radiology. 2015 Jan;274(1):201-9. doi: 10.1148/radiol.14140587. Epub 2014 Oct 14. PMID: 25314006. Return To The Case Studies List.		Back
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