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Arthroscopic Management of a Bennett Lesion in a Baseball Pitcher

March 01, 2020

Contributors: Cesar David Lopez, BS; Julian Sonnenfeld, MD; Hasani Swindell, MD; Charles Mitchell Jobin, MD, FAAOS

Keywords: diagnostic imaging; Impingement

Posterior shoulder injuries in throwing athletes may be debilitating and often are poorly understood. Bennett lesions are defined as extra-articular posterior ossifications associated with posterior labral injury and undersurface rotator cuff damage. Bennett lesions are common in asymptomatic baseball players and other overhead throwing athletes, especially those with many years of playing experience. Bennett lesions are diagnosed radiographically, confirming the presence of a bony spur in the posterior glenoid rim. CT and MRI also may be used for diagnosis. Patients with a Bennett lesion usually are asymptomatic; however, the lesions may become painful and disrupt throwing ability. Patients with a symptomatic Bennett lesion will report posterior shoulder pain during throwing, especially in the follow-through phase, and tenderness at the posteroinferior aspect of the glenohumeral joint. Although no consensus exists, surgical treatment may be indicated in patients who experience continued pain and disability after nonsurgical treatment. Bennett lesion resection is performed arthroscopically or via open surgery. Although the number of cases are limited in scope, several studies have reported that arthroscopic resection of Bennett lesions is associated with favorable clinical and functional outcomes, with most athletes returning to preinjury levels of competition. This video demonstrates arthroscopic management of a symptomatic Bennett lesion in a baseball pitcher. The goals of the procedure are to resect the Bennett lesion and restore shoulder function. The video reviews the indications, contraindications, and techniques for successful arthroscopic resection of a Bennett lesion. Preoperative imaging studies, operating room setup, patient positioning, surgical approach, postoperative management, and expected outcomes are described.

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