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

Case
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Pain with decreased range of motion. Injured playing baseball.

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

  • 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.
  • 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.