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Letter

Rome, Italy

Dear Editor:

I read with much interest the "Current Concepts" article entitled "Injuries to the Shoulder in the Throwing Athlete. Part Two: Evaluation/Treatment" by Dr. Keith Meister (July/August 2000, pages 587–601). I congratulate and thank the author for the detailed analysis of these injuries and for the citations of the papers published by me and my coworkers about suprascapular neuropathy at the spinoglenoid notch in volleyball players. Concerning this topic, the author reports as "a more plausible anatomic explanation" for this abnormality, a mechanism of impingement of the nerve by the medial margin of the tendons of the rotator cuff, which may occur in extreme abduction and external rotation of the shoulder, as described by Sandow and Ilic.² In my opinion, this proposed mechanism of injury, whose mechanics is similar in all the overhead throwing sports activities, does not explain the incidence of this injury in volleyball players, which is significantly and dramatically higher than in other athletes. In our first paper dealing with this syndrome,¹ we analyzed several epidemiologic data, stressing the pathogenetic role of the "floating service," a throwing motion done exclusively by volleyball players. I would like to know Dr. Meister’s opinion about our proposed mechanism of injury, as we believe that the biomechanics of the floating service should still be considered as the most likely explanation for the neuropathy of the suprascapular nerve at the spinoglenoid notch in volleyball players.

REFERENCES

1. Ferretti A, Cerullo G, Russo G: Suprascapular neuropathy in volleyball players. J Bone Joint Surg 69A:260 –263,1987[Abstract/Free Full Text]
2. Sandow MJ, Ilic J: Suprascapular nerve rotator cuff compression syndrome in volleyball players. J Shoulder Elbow Surg 7:516 –521,1998[Medline][Order article via Infotrieve]

Author’s Response

Gainesville, Florida

Dr. Ferretti’s questioning of my interpretation and application of the paper by Sandow and Ilic that discussed a mechanical impingement of the medial margin of the rotator cuff tendons against the notch and nerve is well founded. He is clearly correct in pointing out that although we do occasionally see asymptomatic wasting of the infraspinatus muscle belly in our throwing population, it does not occur with nearly the frequency that it seems to appear in volleyball players. Thus, I probably overcredited the work by Sandow and Ilic as an explanation.

As Dr. Ferretti rightfully points out in his letter, if merely abduction and maximum external rotation were responsible for the findings, then the incidence in our baseball playing population would be much higher. Specifically, the pathogenetic role of the floating service in the development of this disorder may be more substantial.¹ The marked eccentric contraction of the infraspinatus muscle that occurs at the point of impact of the hand against the ball can conceivably result in a stretch to the suprascapular nerve that, when repetitively performed, results in atrophy of the infraspinatus muscle.

My apologies to Dr. Ferretti and my appreciation to him for forcing me to re-think and re-review the literature.

REFERENCE

1. Ferretti A, De Carli A, Fontana M: Injury of the suprascapular nerve at the spinoglenoid notch: The natural history of infraspinatus atrophy in volleyball players. Am J Sports Med 26:759 –763,1998[Abstract/Free Full Text]

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