Latissimus dorsi tendon ruptures are less common injuries that may occur in elite throwing athletes. The latissimus dorsi and the teres major are strong internal rotators of the humerus and are active in the late cocking and acceleration phases of the pitching cycle. Physical examination of a throwing athlete with a latissimus injury may reveal ecchymosis of the upper arm; asymmetry of the posterior axillary fold; and weakness in shoulder adduction, extension, and internal rotation. MRI is used to confirm the diagnosis. Standard shoulder MRIs may not capture the area of interest. If clinical suspicion for a latissimus injury exists, then MRI with an expanded field of view that includes the lateral chest wall may be obtained to visualize the latissimus tendon.

Latissimus tendon ruptures are mostly managed nonsurgically, with surgical repair reserved for professional throwing athletes with full-thickness tears. Nonsurgical management consists of a period of rest and pain control followed by shoulder range of motion exercises, gradual strengthening, and a throwing program. Small case series have reported successful nonsurgical treatment in elite throwing athletes, with a mean return to sports activity of 3 to 6 months postinjury. Proponents of surgical repair believe that surgical treatment may allow elite throwing athletes to return to the same level of sports activity without sacrificing strength. Several case series have reported excellent outcomes in elite throwing athletes who undergo surgical repair, with return to preinjury levels of sports activity. Surgical repair options include the use of suture anchors, cortical suture buttons, or transosseous sutures via a single, posterior axillary incision or via a two-incision technique (standard deltopectoral approach to expose the footprint and posterior axillary incision to expose the retracted tendon). Given the limited literature on this topic, no studies have evaluated the various fixation options or surgical approaches for tendon repair. This video shows the technique for and discusses the technical pearls of latissimus tendon repair via suture button fixation in the lateral decubitus position using a single-incision approach in a professional baseball pitcher.