Superior Bennett lesion: a bone fragment at the posterosuperior glenoid rim in 5 athletes.

In throwing athletes, a Bennett lesion is a bony spur that usually forms at the posteroinferior glenoid rim and sometimes becomes painful. We encountered superior Bennett lesions in the shoulders of 5 athletes, which were detected at the posterosuperior glenoid rim as a separate bone fragment. In all 5 athletes this lesion appeared to be the main cause of shoulder pain during throwing or overhead activity. The lesions were easily visualized on plain radiographs (axial view, scapular Y view, and 45 degrees craniocaudal view) or computed tomography scans. Tenderness was detected over the posterior aspect of the glenohumeral joint, the pain provocation test specific for SLAP lesions was positive, and posterior shoulder pain was elicited by forced external rotation at 90 degrees of abduction in all 5 cases. The pain was diminished or decreased by injection of local anesthetic around the lesion. At arthroscopy, detachment of the posterosuperior labrum and posterior capsular tightness were detected in all 5 cases. Through the detached portion of the posterosuperior labrum, we could easily reach an unstable mobile bone fragment, which was resected arthroscopically. Although the pathologic mechanism is unclear, the mobility of the bone fragment appeared to be related to the occurrence of symptoms.