Abstract
CASE HISTORY: A 21-year-old female diver reported with a chronic history of left anterior shoulder pain with increased forward flexion while diving, accompanied by occasional numbness and tingling radiating to her fingers. The physician suspected thoracic outlet syndrome and a labral tear and advised the patient to continue physical therapy and take analgesics as needed while awaiting the results of the MRI arthrogram. PHYSICAL EXAM: No deformity or asymmetry of the shoulders on inspection. Weakness in the left shoulder’s external rotation and abduction. Range of motion was limited in forward flexion and shoulder abduction, with pain exacerbated by overhead movements and during diving activities. Positive Crank’s test, Dynamic Labral Shear, and Shoulder Apprehension. Negative O’Briens, Empty Can, Neers, and Hawkins. DIFFERENTIAL DIAGNOSES: Thoracic Outlet Syndrome, Labral Tear, Shoulder Impingement Syndrome TESTS & RESULTS: An MRI Arthrography revealed an absent anterior superior labrum consistent with a Buford Complex. FINAL DIAGNOSES: Buford Complex and mid-grade tendinosis of the distal supraspinatus and infraspinatus without a tear. DISCUSSION: The Buford Complex is a cord-like middle glenohumeral ligament with the absence of the anterior superior labrum. This represents the rarest anatomical variant of the shoulder, occurring in approximately 1.5% to 6.5% of the general population. Although it is commonly recognized as a congenital variation of the shoulder, recent studies have demonstrated that this variation may also develop later in life due to untreated shoulder instability during childhood. Patients with a Buford complex are at a higher risk of superior labrum anterior-to-posterior (SLAP) tears. OUTCOME OF THE CASE: Surgical intervention was offered but declined by the patient, who continued with physical therapy focused on improving shoulder flexibility and mobilizing soft tissue. Dry needling and trigger-point injections were also administered; both were well tolerated and effective in managing her symptoms. RETURN TO ACTIVITY AND FURTHER FOLLOW-UP: After ten months of physical therapy, she resumed diving. She continued to focus on stretching, strengthening, and stabilizing shoulder musculature, with her athletic trainer and physician monitoring her symptoms.
Recommended Citation
Lim, Mikaela; Arbel, Vered; Verma, Ankur; and Amasay, Tal
(2026)
"Symptomatic Buford Complex in a Collegiate Diver,"
International Journal of Exercise Science: Conference Proceedings: Vol. 15:
Iss.
9, Article 23.
Available at:
https://digitalcommons.wku.edu/ijesab/vol15/iss9/23