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DISABLEMENT MODEL CASE STUDY 

 

50 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                              Volume 3 – Issue 2 – June 2020 
 

Posterior Glenoid Dysplasia as a Secondary Finding to Labrum Tear 
and Subscapularis Strain: A Case Study 
S. Andrew Cage, MEd, LAT, ATC*†; Brandon J. Warner, MEd, LAT†‡; and Diana M. Gallegos, MS, LAT, 
ATC* 
*University of Texas at Tyler, Tyler, TX; †University of North Carolina Greensboro, Greensboro, NC; ‡Grand Canyon University, 
Phoenix, AZ   
 

 
ABSTRACT 

The purpose of this disablement model case study was to 
describe the case of a collegiate baseball pitcher suffering 
from a labral lesion and supraspinatus strain that may have 
been the result of posterior glenoid dysplasia. Despite gross 
instability and glenohumeral external rotation weakness, the 
patient was initially able to continue to pitch. While posterior 
glenoid dysplasia has been described in literature, there 
have not been studies that have evaluated soft tissue changes 
that may be associated with this bony morphology 
abnormality. In this case, the patient reported to the athletic 
training staff complaining of pain, tightness, and a “clunking” 
sensation in and around his glenohumeral joint. The patient 
reported right shoulder pain being worse following pitching, 
but not experiencing symptoms during the act of pitching. The 
patient was initially treated with cupping and therapeutic 
exercise and was able to continue pitching. As the season 
progressed, the patient reported needing increasingly longer 
time to recover from pitching outings. The patient continued 
to present with a positive O’Brien’s (Active Compression) test, 
weakness with internal and external rotation, and visible 
scapular protraction at rest. Upon referral to the team 
physician, radiographs were ordered to evaluate for bony 
pathology. The patient was diagnosed with posterior glenoid 
dysplasia and referred for magnetic resonance arthrogram. 
This imaging revealed a labrum tear and subscapularis strain. 
The patient was referred for surgery, at which time a labrum 
and subscapularis debridement, and subacromial bursectomy 
were performed. The patient was then instructed to follow up 
with the athletic training staff to initiate therapeutic exercise 
as prescribed by the attending surgeon. When evaluating 
glenohumeral weakness and instability, the clinician must 
consider bony abnormality as a potential factor. If initial 
treatment attempts do not result in improvements, the clinician 
must exhaust all diagnostic options to determine the exact 
nature of the offending pathology. 
Key Phrases 
Glenoid fossa, labrum pathology, rotator cuff 
 
Correspondence 
S. Andrew Cage, University of Texas at Tyler, 11325 
Preakness Dr. Flint, TX 75762. 
E-mail: sacage@uncg.edu   
 
 
 

 
 
Full Citation 
Cage SA, Warner BJ, Gallegos DM. Posterior Glenoid 
Dysplasia as a Secondary Finding to Labrum Tear and 
Subscapularis Strain: A Case Study. Clin Pract Athl Train. 
2020;3(2):50-54. 
https://doi.org/1031622/2020/0002.7.   
Submitted: May 10, 2019 Accepted: June 2, 2020 

INTRODUCTION 

Posterior glenoid dysplasia is a relatively 

uncommon condition affecting the glenoid fossa of 
the scapula.1 Generally, this condition has been 
described in osteoporotic patients, but has also 
been found to have a high incidence in young 
baseball players.1,2 Glenoid dysplasia is believed 
to be the result of a failure of the glenoid pre-
cartilage to ossify during gestation and early 
childhood.1 Additionally, it has been suggested 
that there may be a hereditary component, with 
individuals potentially passing the morphology to 
future generations of their genetic line.3 It has 
been suggested that the stresses applied to the 
anterior and posterior glenoid during overhead 
throwing my result in changes to the structure of 
the glenoid over time.4 While there have been 
some data collected regarding the incidence and 
description of this condition, the authors were 
unable to find a study that reported the effects of 
this abnormal morphology on soft tissue structures 
such as the glenohumeral labrum.1  

In a study examining the role of glenoid 
abnormalities in shoulder pain, Kirimura and his 
colleagues found that 89 of 91 young baseball 
players reporting with shoulder pain exhibited 
posterior glenoid dysplasia.2 Currently the 
primary focus of existing literature is on bony 

mailto:sacage@uncg.edu
https://doi.org/1031622/2020/0002.7


Posterior Glenoid Dysplasia as a Secondary Finding to Labrum Tear and Subscapularis Strain: A Case Study 
 

 

51 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                              Volume 3 – Issue 2 – June 2020  

pathologies associated with this abnormal 
morphology.5 Thus, it is the purpose of this case 
study to describe a labrum tear and subscapularis 
strain of the right shoulder in a collegiate baseball 
player who also exhibited posterior glenoid 
dysplasia. This case will describe the presentation 
of injury, diagnosis, treatment, patient reported 
disablements, and outcomes. 

Patient Information 

The patient described in this case is a 19-year-old 
collegiate baseball pitcher. The patient reported 
a history of long term, high intensity, high 
frequency bouts of pitching, but had previous only 
been troubled by muscular tightness and delayed 
onset muscle soreness in his right shoulder. While 
he did not associate the symptom with pitching or 
pain, the patient also stated that his shoulder 
would “clunk” or “pop” when taken through certain 
motions. The patient noted that he did not 
experience symptoms while pitching, but would 
begin to feel pain and tightness within the first 24-
hours post pitching. Initial evaluation revealed a 
positive O’Brien’s (Active Compression) Test, 
negative Anterior Apprehension Test, negative 
Jobe’s Relocation Test and weakness with 
glenohumeral internal and external rotation. The 
patient was placed on a preventative therapeutic 
exercise program that incorporated cupping 
therapy to address his reported muscular tightness 
and reported instability.  

Differential Diagnosis and Evaluation 

After initially reporting symptoms, the patient was 
evaluated following each pitching outing. The 
patient stated that the pain he was experiencing 
made it difficult to use his right arm during driving, 
and that he was unable to hold his cellular 
telephone in his right arm while talking for an 
extended period of time. The patient reported 
that his pain felt as though it was “too deep to 
touch,” and that while treatment and exercise 
provided temporary relief, he would still 
experience the same level of pain after pitching. 
Given that the patient stated he was experiencing 

increasing levels of dysfunction, and presented 
with positive labrum symptoms, the treating 
athletic trainer made the decision to have the 
patient evaluated by the team physician. At this 
time, the differential diagnosis included: Labrum 
Pathology, Scapular Dyskinesis, Rotator Cuff and 
Scapula Stabilizer Weakness. 

Two weeks after the patient initially reported his 
symptoms, during the team physician’s evaluation, 
it was noted that the patient has multidirectional 
glenohumeral instability. However, instability tests 
did not elicit the pain that the patient stated was 
his primary concern. Following initial evaluation, 
the team physician determined it was necessary to 
pursue diagnostic imaging. Radiographs revealed 
posterior glenoid dysphasia. Consultation with the 
team orthopedic surgeon led to the patient being 
schedule for a magnetic resonance (MR) 
arthrogram to further evaluate the soft tissue 
structures of the shoulder. The MR arthrogram 
revealed significant inflammatory signal, leading 
the orthopedic surgeon to conclude that the 
patient had suffered an injury to his labrum and 
rotator cuff (Figure 1).  

Figure 1. MR Arthrogram of Patient's Right Shoulder 



Posterior Glenoid Dysplasia as a Secondary Finding to Labrum Tear and Subscapularis Strain: A Case Study 
 

 

52 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                              Volume 3 – Issue 2 – June 2020  

At this time, the surgeon explained to the patient 
that without performing arthroscopic surgery it 
would be difficult to fully appreciate the severity 
of the damage to labrum and rotator cuff. The 
patient stated that the intensity and duration of 
the pain he felt following pitching was affecting 
his activities of daily living, and he wished to 
undergo surgery to address any damage that had 
been sustained.  

Body Structure and Function  

Given the injury and patient population, the 
primary diagnostic tools utilized to determine the 
need for an MRI arthrogram were orthopedic 
special tests, strength and range of motion tests, 
and patient reported history. At the initial time of 
injury, the patient presented with full range of 
motion, inability to pitch for long durations, and a 
4/5 strength deficit with glenohumeral internal 
and external rotation. 

Activity and Participation  

In order to help the patient determine if he would 
be able to continue to participate in further 
competitions, the patient was allowed to pitch in 
one more competition following diagnostic 
imaging. The patient stated that while he was 
pitching, he did not notice significant pain. 
However, the patient experienced fatigue faster 
than he normally would have, and was unable to 
pitch longer than two innings. The following day 
the patient reported an increase in pain and 
stiffness compared to his previous pitching 
appearances.  

Environmental and Personal Factors 

Outside of baseball related activities, the patient 
stated that the pain he was experiencing in his 
shoulder was affecting his activities of daily living. 
Specifically, the patient stated that the intensity of 
pain inhibited his ability to obtain adequate 
quality sleep. Additionally, the patient reported 
difficulty turning the steering wheel of his car 
without patient. After his last pitching 

appearance, the patient stated that he was 
unable to brush his hair and teeth without pain. 
Given this increase in pain and the knowledge that 
there was some form of structural damage within 
his shoulder, the patient stated his desire to have 
his injuries surgically addressed as soon as 
possible. When consulting with the team 
orthopedic surgeon, the patient made the decision 
to delay surgery until after he had taken his final 
examinations out of concern for being unable to 
focus properly on his studies.         

INTERVENTION 

Immediately after initially reporting symptoms, 
the patient began participating in a rehabilitation 
plan consisting of elastic tubing and dumbbell 
exercises designed to address the present rotator 
cuff and scapula stabilizer weakness. These 
exercises were completed five to six times a week. 
In addition to these exercises, the patient 
continued to participate in his normal elastic 
tubing and range of motion exercises as part of 
his normal warmup prior to throwing. During this 
time the patient was allowed to continue throwing 
as tolerated.  
 
Once the patient began to experience worsening 
symptoms and it was determined that continuing 
to pitch was not a viable option, the patient was 
instructed to discontinue all throwing and upper 
body weightlifting activities. The patient was then 
consented and scheduled for surgery following his 
final examination. Upon performing arthroscopic 
surgery, the surgeon found subacromial bursitis, a 
20% subscapularis tear and fraying of the labrum 
at the attachment site of the long head of the 
biceps brachii. Based off of these findings, the 
surgeon performed a subacromial bursectomy, 
subscapularis debridement, and biceps brachii 
debridement. During his evaluation, the surgeon 
determined that the present posterior glenoid 
dysphasia was not severe enough to warrant 
surgical correction.  
 



Posterior Glenoid Dysplasia as a Secondary Finding to Labrum Tear and Subscapularis Strain: A Case Study 
 

 

53 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                              Volume 3 – Issue 2 – June 2020  

OUTCOMES 

Body Structure and Function  

After one week of rest following surgery, the 
patient began participating in light range of 
motion and strengthening exercises. As the patient 
regained range of motion and strength, exercises 
progressed in terms of intensity and volume. 
Throughout the progression in exercise the patient 
experienced intermittent bouts of expected 
soreness, but stated that his shoulder was 
beginning to feel increasingly stronger and pain 
free. Within four weeks, the patient had regained 
sufficient strength and range of motion to begin a 
throwing program. Over the course of the summer, 
the patient was able to progress in terms of 
distance and repetitions until he was cleared to 
begin training to pitch during the following fall 
baseball practices.  

Activity and Participation 

Through the surgical intervention and the initiation 
of the therapeutic exercise and throwing 
program, the patient was able to increase his 
amount and distance of throwing in order to be 
prepared to pitch when non-traditional practices 
began the following fall. After throwing, the 
patient noted that his soreness was not as intense 
or severe as it had been prior to surgery and 
rehabilitation. When asked, the patient noted that 
he felt as if he was able to recover more quickly 
than he had been prior to surgery. 

Aside from baseball and pitching, sleep and 
activities of daily living that required extensive 
upper body usage began to grow easier as 
strength and range of motion improved. Had the 
patient not elected to undergo surgery, his 
symptoms would have likely continued to worsen 
to the point where they were affecting his 
activities of daily living even worse. Fortunately, 
the patient lived locally with his family who were 
able to assist him as needed, and he was able to 
complete his final examinations without incident.     

Environmental and Personal Factors 

Given the patient’s expressed desire to be able 
to complete his final examinations in as little pain 
as possible, he remained adherent to his limitation 
regarding throwing and upper body weightlifting. 
Following surgery, the patient adhered to all 
scheduled rehabilitation times and was only 
absent from the athletic training clinic for a short 
period in order to vacation with his family. 
Because the ultimate decision was to discontinue 
activity until the patient’s structural damage could 
be appropriately addressed there were no 
adverse effects from the chosen course of 
treatment.  

DISCUSSION 

This case describes the diagnosis and 
management of a patient suffering from 
subacromial bursitis, labral tear, and 
subscapularis partial tear with a secondary 
finding of posterior glenoid dysphasia. While 
posterior glenoid dysphasia is an uncommon 
finding, it has been described in a number of 
young baseball players complaining of shoulder 
pain.2 Furthermore, in this case the posterior 
glenoid dysphasia did not appear to be the 
source of pain in the patient’s shoulder. The team 
orthopedic physician did state that the glenoid 
dysphasia could have contributed to the humeral 
head resting against the glenoid fossa differently, 
but could not definitively attribute the soft tissue 
damage to the structural abnormality. 

Overall, the choice to discontinue throwing even 
though the patient was still able to pitch 
effectively at the time was made based off the 
patient’s concerns regarding educational goals. 
Had the patient chosen to continue to participate, 
it is possible that they would have been able to 
continue pitching. However, this continued 
participation may have led to worsening 
symptoms or further structural damage. 
Ultimately, the patient was able to return to 
throwing following surgery and therapeutic 
activity, and no adverse outcomes were reported.   



Posterior Glenoid Dysplasia as a Secondary Finding to Labrum Tear and Subscapularis Strain: A Case Study 
 

 

54 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                              Volume 3 – Issue 2 – June 2020  

CLINICAL BOTTOM LINE 

Within the scope of clinical practice, it is entirely 
possible for clinicians to encounter diagnostic 
findings that are not well described in literature. 
In some instances, the available literature may 
indicate that these findings are part of the cause 
of the symptoms with which a patient presents. In 
all cases, clinicians must use their clinical 
qualifications to evaluate and re-evaluate a 
treatment and rehabilitation plan. Should 
conservative treatment fail and surgical 
intervention be warranted, the clinician may learn 
that previous findings were not the ultimate cause 
of a patient’s symptoms. In these cases, a clinician 
must be prepared to adjust their treatment and 
rehabilitation plans accordingly. At all times, a 
clinician must prioritize their patient’s safety and 
personal values. Based off of these values, 
clinicians may change their course of action within 
reason.  

REFERENCES 

1. Seagger RM, Loveridge J, Crowther MAA. 
Beware of glenoid dysplasia mimicking bone 
trauma in the injured shoulder. Int J Shoulder 
Surg. 2009;3(2):37-40. 
https://dx.doi.org/10.4103%2F0973-
6042.57934.  

2. Kirimura K, Nagao M, Sugiyama M. High 
incidence of posterior glenoid dysplasia of 
the shoulder in young baseball players. J 
Shoulder Elbow Surg. 2019;28:82-87. 
https://doi.org/10.1016/j.jse.2018.06.021.  

3. Andrews SN, Smithson SF, Bunker TD. 
Dominant inheritance of primary glenoid 
dysplasia. Report of a father and son. 
Shoulder & Elbow. 2009;1:93-94. 
https://doi.org/10.1111/j.1758-
5740.2009.00024.x.  

4. Mochizuki Y, Natsu K, Kashiwaga K, 
Yasunaga Y, Ochi M. Changes of the 
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bone plate of the glenoid cavity in the 
shoulder joints of throwing athletes. J 
Shoulder Elbow Surg. 2005;14:616-619. 
https://doi.org/10.1016/j.jse.2005.02.016.  
 

5. Walch G, Badet R, Boulahia A, Khoury A. 
Morphologic study of the glenoid in primary 
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https://dx.doi.org/10.4103%2F0973-6042.57934
https://dx.doi.org/10.4103%2F0973-6042.57934
https://doi.org/10.1016/j.jse.2018.06.021
https://doi.org/10.1111/j.1758-5740.2009.00024.x
https://doi.org/10.1111/j.1758-5740.2009.00024.x
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https://doi.org/10.1016/S0883-5403(99)90232-2

