Differential diagnosis of shoulder injuries in sports

Shoulder injuries are common problems in all types of sports. There can be a good deal of variability in how symptoms are expressed from individual to individual, and part of the challenge in understanding the injury is being able to interpret the athlete's complaints as they relate to examination findings and the conditions that produce the symptoms. The history is particularly important because the sensitivity and specificity of many aspects of the examination are variable. A relaxed patient and a systematic evaluation is the best way to be thorough. Radiographs and even MRIs are frequently negative in soft tissue problems in the young athlete. This underscores the importance of a good examination. There may be some utility in using contrast-enhanced MRIs to look at labral pathologic conditions, cysts, or ganglions, but this information is certainly less useful than the patient's description of symptoms and the examiner's findings. With this awareness, we can manage these injuries with more confidence.