Latissimus dorsi costal tear in an elite handball player

Differences in shear elastic modulus of the latissimus dorsi muscle during stretching among varied trunk positions

The latissimus dorsi (LD) can be divided into the upper, middle, and lower parts, but the effective stretching positions for each part are unknown. In this study, we aimed to investigate effective trunk positions for stretching of the LD. A total of 14 healthy males participated in this study. The following seven trunk positions were chosen as the LD stretching positions; upright of the trunk (Baseline), flexion of the trunk (Flex), contralateral bending of the trunk (LB), contralateral rotation of the trunk (Rot), flexion and contralateral bending of the trunk (Flex + LB), flexion and contralateral rotation of the trunk (Flex + Rot), and contralateral bending and contralateral rotation of the trunk (LB + Rot). Maximal elevation of the upper limb was passively added to all positions. The shear elastic modulus, used as the index of muscle elongation, was measured at the four parts (upper, middle, lower, distal parts) of the LD. The shear elastic moduli showed obviously high values in Rot and LB + Rot at the upper, middle, and distal parts, and also in LB, Rot, and LB + Rot at the lower part. These findings suggest that contralateral trunk rotation, or a combination of contralateral trunk bending and rotation are effective trunk positions for stretching all parts of the LD. Contralateral trunk bending was also effective for stretching the lower part of the LD.

Latissimus Dorsi Tear in an Olympics-Level Tennis Player: Case Report and Review of Literature

Latissimus dorsi tears are extremely rare and are encountered primarily in high-level athletes. Noted initially in baseball pitchers, cases have been described in other sports too, with one report of a latissimus dorsi tear at the muscle-tendon junction in a tennis player. Anecdotal outcomes have been comparative after both non-operative and operative treatments. Although no clear indications for operative intervention exist, there is a general consensus that partial non-retracted tears can be managed with non-operative treatment, whereas complete tears warrant surgical repair. This case report describes a complete rupture with retraction of the latissimus dorsi tendon that occurred during a competitive match in an international level tennis player. Due to compelling sports participation reasons, this tear was managed with non-operative treatment. The player returned to competitive tennis within 6 weeks and won the Asian Games men's doubles tennis gold medal 53 days following his injury. He has had no subsequent shoulder-related symptoms despite his continuous participation in international level tennis for the past 18 months. We analyse the role of the latissimus dorsi in tennis and also review the available literature on this uncommon sports injury.

Sports Injuries to the Latissimus Dorsi and Teres Major

Injuries to the latissimus dorsi and teres major muscles, while rare, are debilitating. They are seen in a variety of sports, although disproportionately in the throwing shoulder of baseball pitchers. There have been 25 case reports and 2 case series published on the nonoperative and operative management of these injuries. Latissimus dorsi and teres major muscle anatomy, function, and common injury patterns are well described in these case reports. Also well detailed are the typical patient presentation, physical examination, and imaging findings. Latissimus dorsi tendon injuries are sometimes treated operatively, whereas latissimus dorsi muscle belly or isolated teres major injuries are treated nonoperatively. Nonoperative treatment includes oral anti-inflammatories and shoulder physical therapy. A number of surgical patient positions, approaches, and fixation constructs have been described, although 2 techniques of positioning and surgical approach are used most commonly. Fixation is most often performed with suture anchors. Return-to-play timing, shoulder strength, and healing on magnetic resonance imaging are variable. No standard of care currently exists for the treatment of latissimus dorsi or teres major injuries. If treating a patient with an injury to either muscle, the clinician should be familiar with accumulated experience as reported in the published literature.

Traumatic Tear of the Latissimus Dorsi Myotendinous Junction: Case Report of a CrossFit-Related Injury

A case of a latissimus dorsi myotendinous junction strain in an avid CrossFit athlete is presented. The patient developed acute onset right axillary burning and swelling and subsequent palpable pop with weakness while performing a “muscle up.” Magnetic resonance imaging examination demonstrated a high-grade tear of the right latissimus dorsi myotendinous junction approximately 9 cm proximal to its intact humeral insertion. There were no other injuries to the adjacent shoulder girdle structures. Isolated strain of the latissimus dorsi myotendinous junction is a very rare injury with a scarcity of information available regarding its imaging appearance and preferred treatment. This patient was treated conservatively and was able to resume active CrossFit training within 3 months. At 6 months postinjury, he had only a mild residual functional deficit compared with his preinjury level.