Chronic Adaptation of the Coracohumeral Space and Subscapularis Tendon in Professional Baseball Pitchers

Background: Pitchers frequently experience anterior shoulder pain, possibly associated with coracohumeral impingement; however, whether the coracohumeral distance (CHD) and/or subscapularis tendon adapt chronically (bilateral difference) due to pitching, and whether clinical measures are associated with CHD and subscapularis tendon organization have not been evaluated in professional pitchers. Hypothesis: The authors hypothesized that dominant arm CHD would be smaller than the nondominant arm, dominant subscapularis tendon would have increased spatial frequency (ie, be more disorganized), and humeral retroversion (HR) would predict CHD and subscapularis tendon organization. Level of Evidence: Level 4. Methods: Healthy professional baseball pitchers were recruited during their preseason physical examination. Bilateral diagnostic ultrasound measured CHD, HR, and posterior capsule thickness (PCT), and quantified subscapularis tendon organization. External rotation, neutral, and crossbody CHD was measured. Results: Overall, 52 healthy professional baseball pitchers participated. The dominant arm of pitchers demonstrated a significantly narrower CHD in all 3 positions (P < 0.01), increased scapular protraction (163 vs 156 mm; P < 0.01), and increased spatial frequency of the subscapularis tendon (1.8 vs 1.6 peaks/mm; P < 0.01). HR was associated with CHD in 30 degrees of external rotation (R-2 = 0.12; P < 0.01), neutral rotation (R-2 = 0.11; P < 0.01), and the crossbody position (R-2 = 0.28; P < 0.01). PCT was associated with CHD in 30 degrees of external rotation (R-2 = 0.16; P = 0.05). HR and CHD in 30 degrees of external rotation was associated most strongly with subscapularis tendon organization (R-2 = 0.11; P = 0.03). Conclusion: The dominant shoulder of professional pitchers presents with a smaller CHD, more scapular protraction, and more subscapularis tendon disorganization than the nondominant shoulder. Clinical Relevance: Professional pitchers demonstrate chronic CHD and subscapularis tendon adaptations, which may increase their risk for anterior shoulder pain and subscapularis tendon injury.