21-year-old male pitcher complains of decreased range of motion

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Case History

Pain with decreased range of motion. Injured playing baseball.

Technical Factors

Long- and short-axis fat- and water-weighted images were performed.

Case Findings

Skeletal: Mild-moderate osseous edema as sequela of internal impingement superolateral humeral head. No Hill-Sachs fracture. Nominal swelling along the superior margin of the posterior superior labrum related to cocking mechanism.
Acromioclavicular Joint: Normal. Horizontal acromion. No bursal inflammation. Incidental small cyst at the anterior superior distal clavicle best shown in short-axis.
Rotator Cuff: No full thickness tear. Mild intrinsic signal hyperintensity tendinosis involving the distal fibers supraspinatus and infraspinatus. Teres minor intact. No subscapularis tear.
Biceps/Labrum: Preserved signal intensity within the biceps tendon and anchor. Inferior 6 o’clock position labrocapsular swelling stripping injury with periosteal elevation. No osseous Bankart. No HAGL lesion. Swelling marginates the inferior- medial periosteal and anterior inferior capsular portions of the IGHL.
Coracoid Arch: No anterior arch stenosis. No spurring at the medial or lateral wall of the biceps groove.
Joint Space: Normal fluid signal within the glenohumeral joint. No active capsulitis.
Other Soft Tissue/Marrow: No muscular mass pathologic osseous lesion or evidence of entrapment neuropathy.
Muscles: Muscles are normal in size and signal intensity.

Case Conclusion

Dominant labral ligamentous low grade partial tear axillary 6 o’clock position of the IGHL. Should shoulder pain not resolve dedicated MR arthrogram would be useful for subsequent analysis. Imaging findings are consistent with axillary ligamentous shoulder sprain syndrome.
Impaction pseudocyst as sequela of internal impingement seen with cocking in overhead athletes.
No macrofracture. No osseous glenoid injury.

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