Rosh Emergency Medicine Practice Test

Which is the most likely diagnosis for a baseball pitcher with anterior shoulder pain and a history of glenohumeral subluxation?

1. Biceps tendinitis

2. Multidirectional shoulder instability

3. Rotator cuff tear

4. Superior labrum anterior posterior tear

The correct answer is: Superior labrum anterior posterior tear

The presentation of anterior shoulder pain in a baseball pitcher with a history of glenohumeral subluxation strongly suggests a superior labrum anterior posterior (SLAP) tear. This type of injury is particularly relevant for athletes who engage in repetitive overhead activities, such as pitchers. The slap tear occurs at the junction where the biceps tendon is anchored to the labrum, and it can lead to pain, instability, and a decreased range of motion. In the context of a pitcher, the mechanism of throwing can contribute to this type of injury, especially following episodes of subluxation, where the joint may not stabilize effectively. This lack of stabilization can cause stress on the labrum and result in a tear. The anterior pain correlates with the typical location of symptoms for SLAP lesions, reinforcing the diagnosis. While other conditions are prevalent in athletes, they may not align as closely with both the history of subluxation and the specific pattern of pain. Biceps tendinitis could produce anterior shoulder pain, but it would typically not be this specific without associated instability. Multidirectional shoulder instability is a consideration; however, it usually encompasses a broader range of symptoms beyond just anterior pain. Similarly, a rotator cuff tear could cause pain