What are common shoulder problems in high school girl basketball players?

Common Shoulder Problems in High School Girl Basketball Players

Primary Shoulder Pathologies

High school female basketball players most commonly experience secondary shoulder impingement syndrome and subtle glenohumeral instability, driven by rotator cuff weakness, scapular dyskinesis, and ligamentous laxity rather than structural anatomic abnormalities. 1, 2

Secondary Impingement Syndrome

• Secondary impingement is the predominant pattern in adolescent athletes, occurring when the humeral head fails to maintain proper centering in the glenoid fossa during overhead movements due to rotator cuff weakness combined with ligamentous laxity 1
• This differs fundamentally from primary impingement (structural compression against the acromion), which is rare in adolescents and more common in older adults 1, 3
• Basketball players experience this during shooting, rebounding, and defensive movements that require repetitive overhead arm positioning 1

Clinical presentation includes:

• Anterior or anterolateral shoulder pain that worsens with overhead activities (88% sensitivity) 1
• Pain specifically during the acceleration phase of throwing or shooting motions 1
• Decreased range of motion during abduction with external or internal rotation 1
• Focal weakness in the affected shoulder (present in 75% of cases) 1

Glenohumeral Instability

• Shoulder instability in young female athletes results from repetitive microtrauma and overuse in the setting of generalized ligamentous laxity, not acute traumatic dislocations 2, 4
• The presentation is often subtle and may masquerade as impingement or rotator cuff tenderness, making diagnosis challenging without high clinical suspicion 2, 4
• Female athletes have higher baseline ligamentous laxity compared to males, increasing vulnerability to microinstability 2

Rotator Cuff Pathology

• Undersurface (articular-side) rotator cuff tears from overuse are more common than full-thickness tears in adolescent athletes 5
• These injuries result from atraumatic microinstability and weak rotator cuff muscles rather than degenerative changes 5
• Rotator cuff dysfunction creates a cascade: weakness leads to abnormal humeral head translation, which causes impingement, further weakening the cuff 1, 6

Underlying Biomechanical Factors

Scapular Dyskinesis

• Poor coordination of scapular movements during arm elevation is a primary contributor to shoulder pathology in young athletes 1, 5
• The scapula fails to properly rotate upward and tilt posteriorly during overhead movements, reducing subacromial space 1
• This creates abnormal glenohumeral mechanics and increases rotator cuff stress 7

Muscular Imbalance

• Weakened posterior shoulder musculature combined with overdeveloped anterior musculature creates pathologic biomechanics 1, 5
• Repetitive eccentric stress on the supraspinatus, external rotators, and scapular stabilizers leads to progressive fatigue and injury 1
• The posterior shoulder muscles fail to adequately decelerate the arm during shooting and passing motions 1

Anatomic Vulnerabilities in Adolescents

• Epiphyseal plates remain open until late teens (proximal humerus: 17-18 years; glenoid: 16-18 years) and are weaker than surrounding joint capsules and ligaments 8
• Adolescents produce significantly more type III collagen in ligaments and tendons compared to adults, affecting tissue properties 8
• These anatomic differences make the physis vulnerable to injury from repetitive overhead stress, though physeal injuries are more common in baseball pitchers than basketball players 8

Progressive Pathology if Untreated

• Untreated impingement and instability lead to tendon degeneration with potential progression to partial or full-thickness rotator cuff tears 1, 5
• Athletes experience progressive decrease in shooting velocity and precision as the condition worsens 1
• Chronic rotator cuff dysfunction can result in permanent changes including muscle atrophy and fatty infiltration over 5-10 years 9

Diagnostic Approach

Physical examination findings:

• Neer's test: 88% sensitive, 33% specific for impingement 1
• Hawkins' test: 92% sensitive, 25% specific for impingement 1
• Assessment for scapular dyskinesis during active arm elevation 1, 5
• Evaluation of rotator cuff strength, particularly external rotation compared to contralateral side 5

Imaging algorithm:

• Plain radiographs initially to exclude fractures and bony abnormalities 5
• MRI is optimal for soft tissue evaluation with high sensitivity and specificity for rotator cuff pathology 5
• Ultrasound is equivalent to MRI for rotator cuff assessment (85% sensitivity, 90% specificity) and is operator-dependent 5
• MR arthrography provides superior detection of partial-thickness articular surface tears 5

Critical Clinical Pitfall

The most common diagnostic error is failing to distinguish between primary and secondary impingement. 1, 5 In high school female basketball players, assuming primary structural impingement and treating with subacromial decompression surgery will fail because the underlying problem is dynamic instability and muscle dysfunction, not anatomic crowding. These athletes require rehabilitation focused on rotator cuff strengthening and scapular stabilization, not surgical decompression 2, 7.