Persistent Shoulder Pain in a Recreational Climber: Symptomatic Buford Complex — A Case Report
Abstract:
Background: The Buford complex (BC) is a rare anatomical variant of the shoulder characterized by the absence of the anterosuperior glenoid labrum combined with a thick, cord-like middle glenohumeral ligament (MGHL). Though typically asymptomatic, it can occasionally contribute to shoulder pain or instability and is frequently misinterpreted as a pathologic labral tear during imaging or arthroscopy.
Case Presentation: A 27-year-old right-handed female recreational indoor climber presented with a 10-month his tory of progressive left shoulder pain exacerbated by overhead and traction movements. Physical examination re vealed anterior joint-line tenderness, positive O’Brien’s test, and pain on external rotation in abduction. Ultrasound suggested a paralabral cyst. MR arthrography demonstrated a complete absence of the anterosuperior labrum and a thick cord-like MGHL, consistent with a BC, without labral tear or rotator cuff pathology. A corticosteroid subacro mial injection produced no benefit. The patient underwent a structured physical medicine and rehabilitation program focused on scapulohumeral stability, rotator cuff strengthening, and proprioceptive control. After six weeks, she re ported substantial pain reduction and complete recovery of overhead motion, with full, pain-free return to climbing at three months.
Discussion: The BC may disrupt the normal biomechanics of the glenohumeral joint, becoming symptomatic in athletes engaged in repetitive overhead or traction activities. Correct differentiation from labral pathology on MR arthrography is crucial to avoid misdiagnosis and to guide an effective, conservative management strategy.
Conclusion: Early recognition of a BC and implementation of a structured rehabilitation program focusing on sca pulohumeral stability and neuromuscular control can achieve complete functional recovery and prevent unnecessary surgical intervention.
