High Prevalence of Early Cyst Formation in the Dominant Shoulder of High Performance Junior Elite Javelin Throwers, but not in Junior Elite Volleyball Players: A Basis for a Preventive Shoulder Training?

Purpose A PSI (posteriorsuperior impingement) is frequently seen in the dominant shoulder of adult competitive volleyball and javelin athletes. However, there is a lack of clinical and imaging-based data in a-/oligo-symptomatic junior elite athletes, even though basic approaches for injury prevention should specifically start and focus on this age group. The aim of this study was to evaluate clinical and imaging-based shoulder findings bilaterally in high performance overhead athletes. Material and Methods 30 healthy junior elite athletes competing at national and international levels were included. Two groups were composed of 16 male volleyball players and 14 male javelin throwers. The mean age (±SD) of the volleyball and the javelin group was 16.9 (±1.0) and 17.6 (±0.8) years, respectively. No major trauma or surgery of the both shoulders were found in medical history. All subjects underwent prospective interviews, clinical examination, and shoulder scoring systems (ASES, Rowe Score). A special attention was paid to the GIRD and external rotation in 90° abduction. Bilateral shoulder imaging data were performed using a native 3T-MRI. Results Clinical evaluation demonstrated any specific shoulder pathologies and all subjects had high mean ASES and Rowe score >96 points. A GIRD (glenohmeral internal rotation deficit) of 16.9 (±11.1) ° was found in the volleyball and 9.3 (±9.5) ° in the javelin athletes. The external rotation gain measured 15.0 (±12.5) ° in the dominant shoulders of the volleyball vs. 10.7 (±10.1) ° in the javelin athletes. MRI revealed bony cysts >3 mm at the insertion area of the footprint of the rotator cuff in 71.4% of the dominant shoulders of the javelin athletes compared to only 14.3% in the nondominant shoulder. In contrast, only 12.6% of the volleyball players had these cyst formations in their dominant and 6.3% in their non-dominant shoulders. Discussion A high percentage of a-/oligosymptomatic junior elite athletes already demonstrate structural changes in their dominant shoulders. This is commonly known for adult overhead athletes, but now firstly observed in this young athletic group. The results indicate a high prevalence of GIRD in both groups with more intense occurrence in the volleyball group. MRI indicated osseous signs of overloading especially in the javelin group. This may be caused by repetitive microtrauma due to eccentric loading. Therefore, specific preventive training programs may be dicussed.     «

Purpose A PSI (posteriorsuperior impingement) is frequently seen in the dominant shoulder of adult competitive volleyball and javelin athletes. However, there is a lack of clinical and imaging-based data in a-/oligo-symptomatic junior elite athletes, even though basic approaches for injury prevention should specifically start and focus on this age group. The aim of this study was to evaluate clinical and imaging-based shoulder findings bilaterally in high performance overhead athletes. Mate...     »