Acute Traumatic Tear of Latissimus Dorsi Muscle in an Elite Track Athlete
The patient was a 27-year old female elite track and field athlete (100 m hurdler) who has been competing for the last 10 years in many games, including the Olympic games. She felt contraction around the right axillary region during a weight-training workout (snatch) and a week later, she felt sudden tearing pain after a vigorous start from the crouched position in the blocks. Pain, ecchymosis and swelling at the axilla were the most apparent complaints when she visited a physician 4 days later. Nonsterodial anti-inflammatory drugs and muscle relaxants were prescribed. However her symptoms continued and she was referred to Sports Medicine Department of a tertiary medical center with the presumptive diagnosis of axillary lymphadenopathy 6 weeks after the injury. A soft tissue swelling (3×5 cm) with a gap in the mid portion and ecchymosis along the right posterolateral axillary region was noted on physical examination (). There was no neurologic or vascular anomaly. Shoulder adduction and internal rotation were slightly limited and painful. Manual muscle tests of isometric strength (internal rotation and adduction) were 4/5. US revealed a complete (17 mm long) tear of LD muscle close to the myotendinous junction on the right axillary region. Muscle fibers at both ends were slightly retracted and freely moving. Accompanying hematoma was quite minimal, likely due to late admittance ().\nLD muscle is a large fan-shaped muscle that covers the whole posterolateral aspect of the trunk. The fan-shaped edge originates from multiple sites such as the thoracic, lumbar and sacral spinous processes and the iliac crest then tapers superiorly to insert as a single long tendon to the intertubercular groove of the humerus. Therefore, injuries often occur close to the insertion site (). In our case, a mild grade I muscle sprain to LD, which occurred during snatch exercises, most likely predisposed the muscle to consequent tearing injury. The actual tear (grade II) occurred later when the patient was trying to generate power to run from the crouched position in the block by pushing her trunk forcibly forward while arms were extended, adducted and fixed on the ground. Similar mechanisms were described for slam-dunking in basketball and vaulting in gymnastics.\nOn the basis of patient preference, a conservative approach was preferred rather than surgery; because competitions were close and requiring immediate treatment plan. Presence of an intramuscular tear in an auxiliary muscle, not actively and dominantly involved in running, increased the likelihood of a successful conservative treatment. This was a late admittance case in which 6 weeks had already passed from the time of initial injury; therefore classic physical treatment modalities [protection, rest, ice, compression and elevation (PRICE)] were not closely followed. Antiinflammatory and analgesic medication, kinesiotaping were prescribed. Three-plane shoulder range of motion (ROM) exercises were initiated (10-15 times × 2 sets per day). Within a week, complaints subsided, ROM was full and movements were pain free. Palpation was slightly painful and tender but no swelling was noted. The patient resumed full athletic activity after two weeks of treatment, which made 8 weeks in total after the initial injury. The patient did not have any complaint in the follow-up exam 6 weeks later.