title: Throwing-related injuries of the subscapularis in professional baseball players.
abstract: OBJECTIVE
  To describe the MR appearance of a series of throwing-related injuries to the subscapularis muscle-tendon complex among baseball players.
  
  
  METHODS
  A retrospective review of MR scans of the shoulder in players from 1 professional baseball organization over the course of 5 years was performed to identify cases with findings suggestive of subscapularis injury. These findings were graded and the medical record was reviewed to assess clinical findings, treatment, and follow-up. Preinjury baseline measurements of arm external rotation at 90° of abduction were compared to measurements from a noninjured cohort to evaluate whether this measure is a risk factor for injury.
  
  
  RESULTS
  A total of 133 MR scans of the shoulder were evaluated. Eleven of the scans demonstrated signal changes suggesting subscapularis injury; 10 of these 11 patients had clinical findings supporting a diagnosis of throwing-related subscapularis strain. There were four grade 1, four grade 2, and two grade 3 injuries. All injuries occurred in the inferior half of the subscapularis at the myotendinous junction. Risk of subscapularis injury increased with lower levels of dominant arm external rotation (odds ratio, 1.12; 95% CI, 1.07-1.21; p < 0.001). A threshold of dominant arm external rotation of <106° demonstrated sensitivity of 0.700 (95% CI, 0.392-0.897) and specificity of 0.951 (95% CI, 0.888-0.982) for subscapularis injury.
  
  
  CONCLUSIONS
  Throwing-related subscapularis injuries occur in the inferior half of the muscle at the myotendinous junction. Our data suggest that there is an increased risk of these injuries with lower levels of dominant arm external rotation.
authors: Imaging Institute, Cleveland Clinic, Cleveland, OH, 44195, USA. polstej@ccf.org.
authors: Joshua M
authors: JM
authors: Polster
authors: Center for Shoulder, Elbow and Sports Medicine, Columbia University Medical Center, New York, NY, USA.
authors: T Sean
authors: TS
authors: Lynch
authors: Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
authors: Jennifer A
authors: JA
authors: Bullen
authors: Cleveland Indians, Cleveland, OH, USA.
authors: Lonnie
authors: L
authors: Soloff
authors: Imaging Institute, Cleveland Clinic, Cleveland, OH, USA.
authors: Hakan
authors: H
authors: Ilaslan
authors: Imaging Institute, Cleveland Clinic, Cleveland, OH, USA.
authors: Naveen
authors: N
authors: Subhas
authors: Orthopedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA.
authors: Mark S
authors: MS
authors: Schickendantz
mesh_terms: D000328:Adult; D001134:Arm Injuries / Q000473:pathology; D001265:Athletic Injuries / Q000473:pathology; D001484:Baseball / Q000293:injuries*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D018482:Muscle, Skeletal / Q000293:injuries* / Q000473:pathology; D012189:Retrospective Studies; D000070599:Shoulder Injuries; D012785:Shoulder Joint / Q000473:pathology*; D013708:Tendon Injuries / Q000473:pathology*; D055815:Young Adult
keywords: Baseball; Magnetic resonance; Muscle; Subscapularis; Throwing