[ musculoskeletal imaging ]

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FIGURE 1. Coronal, T2 fat-saturated magnetic resonance image of the right shoulder FIGURE 2. Axial, T2 fat-saturated magnetic resonance image of the right shoulder showing
showing slight widening of the lateral physis (orange arrow), with edema in both the bony edema (arrow).
adjacent metaphysis and epiphysis (blue arrows).

Salter-Harris Fracture of the Proximal

Humerus in an Adolescent Gymnast
J Orthop Sports Phys Ther 2018.48:729-729.

MARIE KOSNIK, DPT, OCS,University of Southern California, Los Angeles, CA.

STEPHEN PAULSETH, DPT, SCS,University of Southern California, Los Angeles, CA.
ALEX ABZUG, DPT, OCS,University of Southern California, Los Angeles, CA.

A
13-year-old male gymnast pre-
sented via direct access to physi-
cal therapy with a chief complaint
of insidious-onset right anterolateral
shoulder pain, which began 3 months
prior. His pain occurred only when per-
forming on the rings and high bar. The
patient participated in gymnastics at a
frequency of 6 days per week, averaging
30 hours per week.
The patient’s active and passive shoul-
der range of motion in all directions was
normal. All directions except external
rotation were painful at end range. Ten-
derness was noted along the long head of
the biceps tendon. Based on the activities
that produced the patient’s symptoms
and a positive biceps load II test, a labral
tear was suspected.
The patient was advised to avoid any
gymnastic activities that might cause pain
while completing stretching and neuro-
muscular training over the following 2
weeks. Due to continued symptoms, the
patient was referred to an orthopaedist.
Radiographs were performed, followed
by magnetic resonance imaging without
contrast. Magnetic resonance imaging
showed slight widening of the lateral
physis, with edema in both the adjacent
metaphysis and epiphysis1 (FIGURES 1 and
2). The patient was diagnosed with a type
1 Salter-Harris fracture, and the ortho-
paedist ordered the patient to rest for 4
weeks. Following his rest, the patient was
able to resume gymnastics without limita-
tions and remained asymptomatic. This
case illustrates the role of early referral
in athletes not improving with conser-
vative physical therapy, and the utility
of imaging in providing a definitive di-
agnosis to aid in the management of a
Salter-Harris fracture. t J Orthop Sports
Phys Ther 2018;48(9):729. doi:10.2519/
jospt.2018.7296

Reference
1. Jaramillo D, Hoffer FA, Shapiro F, Rand F. MR imaging of fractures of the growth plate. AJR Am J Roentgenol. 1990;155:1261-1265. https://doi.org/10.2214/ajr.155.6.2122677

journal of orthopaedic & sports physical therapy | volume 48 | number 9 | september 2018 | 729