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Glenoid OCD In Baseball

Christopher S. Ahmad, MDHead Team Physician, New York YankeesHead Team Physician, New York City Football ClubChief, Sports Medicine ServiceVice Chair of Clinical ResearchProfessor, Clinical Orthopaedic SurgeryColumbia University Medical Center

Disclosure1. Basic Science Support

a. Arthrexb. Smith-Nephew

2. Consultant a. Arthrex

3. Royaltiesa. Arthrexb. Lead Player Publishing

4. Board Member1. Baseball Health Network2. Sports Science Institute of America

Case

• 22M pro position player (bats R/throws R)

• R shoulder pain

• Mechanical symptoms

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Glenoid OCD

Osteochronditis Dissecans (OCD)

• Med Femoral Condyle

• Capitellum

• Talus

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Capitellar OCD

What is OCD?

• Focal osteonecrosis with subchondral separation

• Pain, mechanical sx, flexion contracture

• Treatment depends on degree of separation and size of lesion

Capitellar OCD

Why ?

Ischemia

Repetitive microtrauma

• Immature capitellarepiphysis supplied by one or two vessels

• End artery supply

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Capitellar OCD

High prevalence

• Male throwers

• Female gymnasts

Capitellar OCD

Stage 1: non-displaced

Treat non-operatively

Capitellar OCD

• Stage 2: partially separated

• In situ fixation - low healing rate

• Debridement/drilling

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Capitellar OCD

• Stage 3: fully displaced

• Loose body removal

• Debridement/drilling

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Glenohumeral Forces

Glenoid OCD

Glenohumeral Forces

Compressive Force

• 480N Shoulder

• 270N Elbow

• Scapular mechanics

• Throwing mechanics

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Case

• 22M pro position player (bats R/throws R)

• R shoulder pain

• Mechanical symptoms

Glenoid OCD

Glenoid OCD

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Glenoid OCDLabral Repair

CASE 2

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• 19 yo RHD M

• Collegiate shortstop

• Right shoulder pain x 6 months

• No trauma

• Denies mech symptoms

• Failed rest PT, NSAIDs, injection

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Physical Examination

• Pain with posterior load and shift

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Imaging

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Glenoid OCD

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Glenoid OCD22

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Week 0 – 6: Immediate active ROM without resistance

Week 6 – 16: Gentle Strengthening

Week 16: Throwing

Rehab

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Literature Limited to Case reports

• Gogus A, Ozturk C. Osteochondritis dissecans of the glenoid cavity: a case report. Arch Orthop Trauma Surg. 2008 May;128(5):457-60. Epub 2008 Jan 4.

• Shanley DJ, Mulligan ME. Osteochondrosis dissecans of the glenoid. Skeletal Radiol. 1990;19(6):419-21.

• Nishinaka N, Tsutsui H, Mihara K, et al. A case report: painful throwing shoulder accompanied by a peculiar glenoid osteochondral injury. Shoulder Joint. 2002;26 (3):419-22.

• Rossi F, Dragoni S. Osteochondrosis dissecans of the shoulder glenoid fossa diagnosed in four throwing athletes. J Sports Med Phys Fitness. 2006 Mar;46 (1):111-5.

Outcomes

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Mark 21 yo collegiate outfielder

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Anthony 21 right handed collegiate pitcher

• Mark and Anthony attend same college

• Mark and Anthony are twins

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• Repetitive compressive forces

• Problem of bone not supporting cartilage

• More common in elbow than shoulder

• Arthroscopic treatment can be successful

Glenoid OCD Summary

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Thank You