Symptomatic Thrower’s Exostosis
abstract & commentary
Synopsis: Patients with larger posterior osteophytes were more likely to have poor results on an arthroscopic evaluation.
Source: Meister K, et al. Symptomatic thrower’s exostosis. Arthroscopic evaluation and treatment. Am J Sports Med 1999;27(2):133-136.
Meister and colleagues described a lesion of the posterior glenoid, a moderately sized osteophyte, that has been found in symptomatic overhead athletes. These athletes experienced pain during cocking, acceleration, and the follow-through phases of throwing. They all underwent arthroscopic evaluation. Fifteen were found to have a tear of the posterior labrum, four had fraying of the anterior labrum, and 21 had partial tears of the undersurface of the rotator cuff as well as the osteophyte. A debridement of the cuff and labral lesions was followed by resection of the posterior osteophyte in 11 of these patients. Follow-up evaluation revealed that approximately 55% had returned to their premorbid level of throwing, remained asymptomatic, and maintained a high level of performance for a mean of 3.6 years. Five of these players are still participating at the major league level, and five had retired at the latest follow-up. There was only one recurrence of the exostosis. Meister et al believe that patients with larger posterior osteophytes were more likely to have a poor result.
Comment by James P. Tasto, MD
Posterior shoulder pain has been recognized in the throwing athlete as a difficult problem over the years, and a number of potential causes have been identified. There have been other reports of capsular caldification and posterior osteophytes; their etiology as well as their treatment and results of treatment have remained quite varied. A number of causes of the development of the thrower’s exostosis have also been described by a number of authors, and their etiology remains controversial. A number of etiologies have been set forth, including repetitive traction on the posterior capsule and triceps traction on the posterior inferior aspect of the glenoid. Other authors, however, feel that the triceps is not associated with this exostosis. Some investigators postulate that the osteophyte is a direct result of "internal impingement"—direct compression of the posterior glenoid in the cocking phase of throwing.
It is important to attempt to define the etiology of posterior shoulder pain in the overhead athlete. Mild overuse syndrome, caused by such things as teres minor tendinitis and mild posterior capsulitis, should be ruled out. When the posterior pain does not respond to conservative care, further workup is indicated, which may eventually result in arthroscopic surgery. Findings on physical examination usually include tenderness about the posterior and inferior glenoids. CT arthrography and plain CT scans are quite helpful. Plain x-rays, including Bennett and Stryker notch views, can also be helpful in defining the posterior glenoid exostosis.
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