Latissimus Dorsi Repair
Latissimus dorsi avulsion injuries from the proximal humerus are rare and occur most often in competitive athletes. The standard of care for this injury is yet to be established. The literature includes only case reports and case series; evidence-based guidelines for appropriate management of this injury are lacking. Most reported cases have occurred in high-level athletes, from water skiers and steer wrestlers to rock climbers and professional baseball pitchers. There is no consistency in how these cases were managed. Many authors have suggested that nonoperative treatment is the preferred strategy, even in high-level athletes. Other authors have suggested that operative intervention better preserves anatomy, strength, function in high-level athletes, and with unsuccessful nonoperative treatment, may lead to delayed or limited ability to return to sports. For recreational or noncompetitive athletes, nonoperative management of latissimus tears is likely to produce satisfactory outcomes, as the shoulder compensates for loss of latissimus strength and function through the activity of surrounding synergistic muscles. For competitive athletes, however, primary surgical repair may offer the best chance for successful return to sports at a high functional capacity and with few postsurgical strength deficits.