Body Builder's Shoulder: Posterior Labrum Periosteal Sleeve Avulsion (POLPSA) and Glenoid Posterior Rim Stress Fracture due to Intense Bench Pressing

Background. Shoulder overuse, both occupational and sports-related, is a major cause of shoulder pain with an estimated incidence of 0.9%-2.5% in the general population and a prevalence of 7%-27% in Europe and United States. We report on a young amateur bodybuilder presenting with a complex shoulder overuse lesion. A posterior labrum periosteal sleeve avulsion (POLPSA) with a chondral lesion of the posterior glenoid cavity and a SLAP lesion was diagnosed. Case presentation. A 33-year-old male construction worker complained of 9 months worsening right shoulder pain. He was an amateur body builder who would bench press heavy weights (up to 170 kg). A magnetic resonance arthrogram showed a posterior labrum sleeve avulsion, a stress chondral fracture of the posterior glenoid cavity and a SLAP lesion. Arthroscopic repair of the bicipital anchor, posterior labrum fixation and removal of the chondral fragment, proved successful and allowed the patient to return to his previous sports activity. Conclusions. Bench press creates major forces along the anteroposter axis of the upper limbs, pushing the humeral head posteriorly and increasing joint reaction force on the posterior glenoid quadrant considerably as the scapula is locked resting on the bench. This may result in a tendency for the humeral head to subluxate posteriorly which, aggravated by the high number of repetitions, puts the posterior labrum and capsula under very high stress eventually leading to labrum failure. Arthroscopic repair was shown to restore shoulder function in these athletes.