To clarify the clinical effectiveness of arthroscopic treatment for painful Bennett lesions, we retrospectively studied 6 baseball players. None of them responded to conservative treatment and the mean duration of symptoms before operation was 28 months (12-36). The mean age at operation was 26 years (17-42) and the mean follow-up period was 23 months (12-36). The only consistent physical finding was tenderness over the posteroinferior glenoid region. Posterior pain on forced forward elevation and on forced abduction/external rotation of the shoulder was observed in 3 patients each. Two patients had slight posterior and inferior laxity. The local anesthetic throwing test under fluoroscopic control was performed in all patients before arthroscopy. After this test, all the patients could throw with significant pain relief. Bulging of the posteroinferior glenoid labrum was observed in all the patients arthroscopically. All the patients underwent arthroscopic removal of the Bennett lesion. In the last 3 patients, we performed a reattachment of the glenoid labrum using suture anchors or a capsular repair by the suture punch technique. Associated lesions were detachment of the superior glenoid labrum in 3 cases and an articular-side partial rotator cuff tear in two. These lesions were partially debrided. At 2-3 months, throwing was started and a return to preinjury or vigorous throwing activity was allowed at 6 months. At follow-up, all the patients noted a reduction of both tenderness and throwing pain, but pain-free throwing was achieved in 4 only. All the patients could continue to play baseball, and 5 of them returned to their preinjury performance level. Therefore, the overall success rate was 83% (5/6). Thus, arthroscopic treatment of painful Bennett lesions achieves a successful outcome. In addition, a positive local anesthetic throwing test is a good indication for this procedure.
