A 24-year-old male football player presented after landing on the ‘point’ of his left shoulder during a match. Since this incident he has experienced clicking, stiffness and a reduced range of motion in his shoulder. He had a Bankart repair four years previously (but did not have any ongoing morbidity). On examination, he had 0° of external rotation in his left shoulder with a bony block (hard end point), which did not improve with scapular stabilisation and assistance. Shoulder abduction and forward flexion movements were also limited.
X-rays of the left shoulder joint illustrate a large bony ossicle lying in the axillary recess. With a second bony ossicle within the subscapularis bursa. There is no radiographic evidence of a Hill-Sachs lesion or a periosteal reaction. The acromioclavicular joint is normal. The player subsequently had an MRI which showed extensive chondral loss of the glenohumeral joint with associated synovitis and loose intra-articular bodies.
This player had a shoulder arthroscopy and removal of the loose body. Following surgery there was a marked improvement in his shoulder range of motion (and other symptoms). He was subsequently treated with rehabilitation and made a progressive return to play. The medium- and long-term significance of the glenohumeral joint chondral loss is uncertain.
The reported mechanism of injury more commonly causes an acromio-clavicular joint injury; however, the clinical finding of a limited range of motion and joint crepitus prompted further evaluation. It is likely that the ossicle seen in this case was an avulsion fracture sustained after his initial injury, that has rounded off and become corticated. It is likely that the recent fall has caused the ossicle to move into an obstructive position within the joint space.
The association between shoulder instability and the development of glenohumeral joint osteoarthritis (OA) has not been well studied. It is clear that some degree of chondral damage occurs during an instability event and that there is an increased risk of developing OA for patients with a history of instability. How common this is, and what patients are most at risk of developing OA, remains unclear. In some situations, surgical treatment itself may also increase the risk of developing OA. Patients who have limited external rotation following surgery, of those who have procedures to correct hardware that migrates into the joint (a relatively rare event), appear to be most at risk.
FIFA does not bear any responsibility for the accuracy and completeness of any information provided in the “Radiology Review” features and cannot be held liable with regard to the information provided or any acts or omissions occurring on the basis of this information.