Advertisement

The Role of the Scapula in the Overhead Athlete

  • W. Ben Kibler
  • Stephen J. Thomas
  • Aaron D. SciasciaEmail author
Chapter

Abstract

The scapula serves many roles in shoulder function including serving as a stable base for muscle activation, dynamically moving in relation to the arm to create precise concavity/compression ball and socket kinematics throughout arm motion, providing through its dynamic stability optimal force and energy transfer from the core to the hand, and moving to allow maximum arm abduction/external rotation. The most effective scapular position to achieve these goals is retraction, and the most effective motion is retraction and controlled protraction. The loss of retraction can be caused by anatomical disruption (tissue derangement), anatomical impairment (tissue inflexibility, strength imbalance), or kinetic chain impairment (lower extremity inflexibility or weakness). These disruptions and impairments can alter scapular resting position and/or dynamic motion control and create scapular dyskinesis. Understanding how the scapula is stabilized and moves, what controls its movements, how its movements are integrated with arm movements, and the results of this integration in normal use and in shoulder injury will allow understanding of its roles in throwing and other overhead activities.

Keywords

Scapula Scapular kinematics Kinetic chain; Overhead throwing 

References

  1. 1.
    Cain PR, Mutschler TA, Fu FH, Lee SK. Anterior instability of the glenohumeral joint: a dynamic model. Am J Sports Med. 1987;15(2):144–8.PubMedCrossRefGoogle Scholar
  2. 2.
    Clabbers KM, Kelly JD, Bader D, Eager M, Imhauser C, Siegler S, et al. Effect of posterior capsule tightness on glenohumeral translation in the late-cocking phase of pitching. J Sport Rehabil. 2007;16(1):41–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Nirschl RP. Tennis elbow. Orthop Clin North Am. 1973;4(3):787–800.PubMedGoogle Scholar
  4. 4.
    Conway JE. Arthroscopic repair of partial-thickness rotator cuff tears and SLAP lesions in professional baseball players. Orthop Clin N Am. 2001;32(3):443–56.CrossRefGoogle Scholar
  5. 5.
    Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology part III: the SICK scapula, scapular dyskinesis, the kinetic chain, and rehabilitation. Arthroscopy. 2003;19(6):641–61.CrossRefGoogle Scholar
  6. 6.
    Kibler WB. The role of the scapula in athletic function. Am J Sports Med. 1998;26:325–37.CrossRefGoogle Scholar
  7. 7.
    Kibler WB, Ludewig PM, McClure PW, Michener LA, Bak K, Sciascia AD. Clinical implications of scapular dyskinesis in shoulder injury: the 2013 consensus statement from the “scapula summit”. Br J Sports Med. 2013;47:877–85.CrossRefGoogle Scholar
  8. 8.
    Pappas AM, Zawacki RM, Sullivan TJ. Biomechanics of baseball pitching a preliminary report. Am J Sports Med. 1985;13:216–22.CrossRefGoogle Scholar
  9. 9.
    McClure PW, Michener LA, Sennett BJ, Karduna AR. Direct 3-dimensional measurement of scapular kinematics during dynamic movements in vivo. J Shoulder Elb Surg. 2001;10:269–77.CrossRefGoogle Scholar
  10. 10.
    Kibler WB, McMullen J. Scapular dyskinesis and its relation to shoulder pain. J Am Acad Orthop Surg. 2003;11:142–51.PubMedCrossRefGoogle Scholar
  11. 11.
    Ludewig PM, Phadke V, Braman JP, Hassett DR, Cieminski CJ, LaPrade RF. Motion of the shoulder complex during multiplanar humeral elevation. J Bone Joint Surg Am. 2009;91A(2):378–89.CrossRefGoogle Scholar
  12. 12.
    Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology part I: pathoanatomy and biomechanics. Arthroscopy. 2003;19(4):404–20.CrossRefGoogle Scholar
  13. 13.
    Uhl TL, Kibler WB, Gecewich B, Tripp BL. Evaluation of clinical assessment methods for scapular dyskinesis. Arthroscopy. 2009;25(11):1240–8.CrossRefGoogle Scholar
  14. 14.
    Kibler WB, Ludewig PM, McClure PW, Uhl TL, Sciascia AD. Scapula summit 2009. J Orthop Sports Phys Ther. 2009;39(11):A1–A13.PubMedCrossRefGoogle Scholar
  15. 15.
    Myers JB, Laudner KG, Pasquale MR, Bradley JP, Lephart SM. Scapular position and orientation in throwing athletes. Am J Sports Med. 2005;33(2):263–71.CrossRefGoogle Scholar
  16. 16.
    Laudner KG, Myers JB, Pasquale MR, Bradley JP, Lephart SM. Scapular dysfunction in throwers with pathologic internal impingement. J Orthop Sports Phys Ther. 2006;36(7):485–94.CrossRefGoogle Scholar
  17. 17.
    Laudner KG, Stanek JM, Meister K. Differences in scapular upward rotation between baseball pitchers and position players. Am J Sports Med. 2007;35:2091–5.PubMedCrossRefGoogle Scholar
  18. 18.
    Veeger HEJ, van der Helm FCT. Shoulder function: the perfect compromise between mobility and stability. J Biomech. 2007;40:2119–29.CrossRefGoogle Scholar
  19. 19.
    Speer KP, Garrett WE. Muscular control of motion and stability about the pectoral girdle. In: Matsen Iii FA, Fu F, Hawkins RJ, editors. The shoulder: a balance of mobility and stability. Rosemont: American Academy of Orthopaedic Surgeons; 1994. p. 159–73.Google Scholar
  20. 20.
    Bagg SD, Forrest WJ. A biomechanical analysis of scapular rotation during arm abduction in the scapular plane. Am J Phys Med Rehabil. 1988;67:238–45.PubMedGoogle Scholar
  21. 21.
    Kibler WB, Chandler TJ, Shapiro R, Conuel M. Muscle activation in coupled scapulohumeral motions in the high performance tennis serve. Br J Sports Med. 2007;41:745–9.PubMedPubMedCentralCrossRefGoogle Scholar
  22. 22.
    van-der-Helm FC. Analysis of the kinematic and dynamic behavior of the shoulder mechanism. J Biomech. 1994;27(5):527–50.PubMedCrossRefGoogle Scholar
  23. 23.
    Ludewig PM, Reynolds JF. The association of scapular kinematics and glenohumeral joint pathologies. J Orthop Sports Phys Ther. 2009;39(2):90–104.PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    Kibler WB, Press J, Sciascia AD. The role of core stability in athletic function. Sports Med. 2006;36(3):189–98.CrossRefGoogle Scholar
  25. 25.
    Sciascia AD, Thigpen CA, Namdari S, Baldwin K. Kinetic chain abnormalities in the athletic shoulder. Sports Med Arthrosc Rev. 2012;20(1):16–21.CrossRefGoogle Scholar
  26. 26.
    Sahara W, Sugamoto K, Murai M, Yoshikawa H. Three-dimensional clavicular and acromioclavicular rotations during arm abduction using vertically open MRI. J Orthop Res. 2007;25:1243–9.CrossRefGoogle Scholar
  27. 27.
    Putnam CA. Sequential motions of body segments in striking and throwing skills: description and explanations. J Biomech. 1993;26:125–35.CrossRefGoogle Scholar
  28. 28.
    Hirashima M, Kadota H, Sakurai S, Kudo K, Ohtsuki T. Sequential muscle activity and its functional role in the upper extremity and trunk during overarm throwing. J Sports Sci. 2002;20:301–10.CrossRefGoogle Scholar
  29. 29.
    Kibler WB. Biomechanical analysis of the shoulder during tennis activities. Clin Sports Med. 1995;14:79–85.Google Scholar
  30. 30.
    Hirashima M, Yamane K, Nakamura Y, Ohtsuki T. Kinetic chain of overarm throwing in terms of joint rotations revealed by induced acceleration analysis. J Biomech. 2008;41:2874–83.CrossRefGoogle Scholar
  31. 31.
    Hirashima M, Kudo K, Watarai K, Ohtsuki T. Control of 3D limb dynamics in unconstrained overarm throws of different speeds performed by skilled baseball players. J Neurophysiol. 2007;97(1):680–91.CrossRefGoogle Scholar
  32. 32.
    Kibler WB. Role of the scapula in the overhead throwing motion. Contemp Orthop. 1991;22(5):525–32.Google Scholar
  33. 33.
    Fleisig GS, Andrews JR, Dillman CJ, Escamilla RF. Kinetics of baseball pitching with implications about injury mechanisms. Am J Sports Med. 1995;23(2):233–9.CrossRefGoogle Scholar
  34. 34.
    Nieminen H, Niemi J, Takala EP, Viikari-Juntura E. Load-sharing patterns in the shoulder during isometric flexion tasks. J Biomech. 1995;28(5):555–66.CrossRefGoogle Scholar
  35. 35.
    Lippitt S, Vanderhooft JE, Harris SL, Sidles JA, Harryman Ii DT, Matsen Iii FA. Glenohumeral stability from concavity-compression: a quantitative analysis. J Shoulder Elb Surg. 1993;2(1):27–35.CrossRefGoogle Scholar
  36. 36.
    Kebaetse M, McClure PW, Pratt N. Thoracic position effect on shoulder range of motion, strength, and three-dimensional scapular kinematics. Arch Phys Med Rehabil. 1999;80:945–50.PubMedCrossRefGoogle Scholar
  37. 37.
    Smith J, Kotajarvi BR, Padgett DJ, Eischen JJ. Effect of scapular protraction and retraction on isometric shoulder elevation strength. Arch Phys Med Rehabil. 2002;83:367–70.PubMedPubMedCentralCrossRefGoogle Scholar
  38. 38.
    Kibler WB, Sciascia AD, Dome DC. Evaluation of apparent and absolute supraspinatus strength in patients with shoulder injury using the scapular retraction test. Am J Sports Med. 2006;34(10):1643–7.CrossRefGoogle Scholar
  39. 39.
    Tate AR, McClure P, Kareha S, Irwin D. Effect of the scapula reposition test on shoulder impingement symptoms and elevation strength in overhead athletes. J Orthop Sports Phys Ther. 2008;38(1):4–11.CrossRefGoogle Scholar
  40. 40.
    Fleisig GS, Barrentine SW, Escamilla RF, Andrews JR. Biomechanics of overhand throwing with implications for injuries. Sports Med. 1996;21:421–37.PubMedPubMedCentralCrossRefGoogle Scholar
  41. 41.
    Tripp BL, Boswell LL, Gansneder BM, Shultz SJ. Functional fatigue decreases three-dimensional multi-joint position reproduction acuity in the overhead throwing athlete. J Athl Train. 2004;39(4):316–20.PubMedPubMedCentralGoogle Scholar
  42. 42.
    Tripp B, Uhl TL, Mattacola CG, Srinivasan C, Shapiro R. Functional multijoint position reproduction acuity in overhead athletes. J Athl Train. 2006;41(2):146–53.PubMedPubMedCentralGoogle Scholar
  43. 43.
    Park GY, Lee SM, Lee MY. Diagnostic value of ultrasonography for clinical medial epicondylitis. Arch Phys Med Rehabil. 2008;89:738–42.CrossRefGoogle Scholar
  44. 44.
    Bailey LB, Shanley E, Hawkins R, Beattie PF, Fritz S, Kwartowitz D, et al. Mechanisms of shoulder range of motion deficits in asymptomatic baseball players. Am J Sports Med. 2015;43:2783.PubMedCrossRefGoogle Scholar
  45. 45.
    Kibler WB, Uhl TL, Maddux JWQ, Brooks PV, Zeller B, McMullen J. Qualitative clinical evaluation of scapular dysfunction: a reliability study. J Shoulder Elb Surg. 2002;11:550–6.CrossRefGoogle Scholar
  46. 46.
    Warner JJP, Micheli LJ, Arslanian LE, Kennedy J, Kennedy R. Scapulothoracic motion in normal shoulders and shoulders with glenohumeral instability and impingement syndrome. Clin Orthop Relat Res. 1992;285(191):199.Google Scholar
  47. 47.
    Paletta GA, Warner JJP, Warren RF, Deutsch A, Altchek DW. Shoulder kinematics with two-plane x-ray evaluation in patients with anterior instability or rotator cuff tears. J Shoulder Elb Surg. 1997;6:516–27.CrossRefGoogle Scholar
  48. 48.
    Weiser WM, Lee TQ, McQuade KJ. Effects of simulated scapular protraction on anterior glenohumeral stability. Am J Sports Med. 1999;27:801–5.CrossRefGoogle Scholar
  49. 49.
    Sarkar S, Seeley S, Beranek K, Blom K, Braman JP, Ludewig PM. Rotator cuff proximity to potential impinging structures during clinical impingement tests. Paper presented at: IXth conference of the International Shoulder Group2012; Wales, UK.Google Scholar
  50. 50.
    Gumina S, Carbone S, Postacchini F. Scapular dyskinesis and SICK scapula syndrome in patients with chronic type III acromioclavicular dislocation. Arthroscopy. 2009;25(1):40–5.CrossRefGoogle Scholar
  51. 51.
    de Visser HM, Reijman M, Heijboer MP, Bos PK. Risk factors of recurrent hamstring injuries: a systematic review. Br J Sports Med. 2012;46:124–30.PubMedCrossRefGoogle Scholar
  52. 52.
    Kibler WB, Sciascia A, Uhl T. Medial scapular muscle detachment: clinical presentation and surgical treatment. J Shoulder Elb Surg. 2014;23(1):58–67.CrossRefGoogle Scholar
  53. 53.
    Seymour EQ. Osteolysis of the clavicular tip associated with repeated minor trauma to the shoulder. Radiology. 1977;123(1):56.PubMedCrossRefGoogle Scholar
  54. 54.
    Matsumura N, Ikegami H, Nakamichi N, Nakamura T, Nagura T, Imanishi N, et al. Effect of shortening deformity of the clavicle on scapular kinematics: a cadaveric study. Am J Sports Med. 2010;38(5):1000–6.PubMedCrossRefGoogle Scholar
  55. 55.
    Sciascia AD, Morris BJ, Jacobs CA, Edwards TB. Responsiveness and internal validity of common patient-reported outcome measures following Total shoulder arthroplasty. Orthopedics. 2017;40(3):e513–9.PubMedCrossRefGoogle Scholar
  56. 56.
    Descatha A, Dale AM, Jaegers L, Herquelot E, Evanoff B. Self-reported physical exposure association with medial and lateral epicondylitis incidence in a large longitudinal study. Occup Environ Med. 2013;70:670–3.PubMedPubMedCentralCrossRefGoogle Scholar
  57. 57.
    Kibler WB. Scapular surgery I-IV. In: Reider B, Terry MA, Provencher MT, editors. Sports medicine surgery. Philadelphia: Elsevier Saunders; 2010. p. 237–67.Google Scholar
  58. 58.
    Barden JM, Balyk R, Raso VJ. Atypical shoulder muscle activation in multidirectional instability. Clin Neurophysiol. 2005;116:1846–57.PubMedCrossRefGoogle Scholar
  59. 59.
    Illyes A, Kiss RM. Kinematic and muscle activity characteristics of multidirectional shoulder joint instability during elevation. Knee Surg Sports Traumatol Arthrosc. 2006;14:673–85.PubMedCrossRefGoogle Scholar
  60. 60.
    Ogston JB, Ludewig PM. Differences in 3-dimensional shoulder kinematics between persons with multidirectional instability and asymptomatic controls. Am J Sports Med. 2007;35:1361–70.PubMedCrossRefGoogle Scholar
  61. 61.
    Kibler WB, Kuhn JE, Wilk KE, Sciascia AD, Moore SD, Laudner KG, et al. The disabled throwing shoulder - Spectrum of pathology: 10 year update. Arthroscopy. 2013;29(1):141–61.CrossRefGoogle Scholar
  62. 62.
    Reuther KE, Thomas SJ, Tucker JJ, Yannascoli SM, Caro AC, Vafa RP, et al. Scapular dyskinesis is detrimental to shoulder tendon properties and joint mechanics in a rat model. J Orthop Res. 2014;32(11):1436–43.PubMedPubMedCentralCrossRefGoogle Scholar
  63. 63.
    Fairbank SM, Corlett RJ. The role of the extensor digitorum communis muscle in lateral epicondylitis. J Hand Surg (Br). 2002;27(5):405–9.CrossRefGoogle Scholar
  64. 64.
    Butterfield TA. Eccentric exercise in vivo: strain-induced muscle damage and adaptation in a stable system. Exerc Sport Sci Rev. 2010;38(2):51–60.PubMedPubMedCentralCrossRefGoogle Scholar
  65. 65.
    Amin NH, Ryan J, Fening SD, Soloff L, Schickendantz MS, Jones M. The relationship between Glenohumeral internal rotational deficits, total range of motion, and shoulder strength in professional baseball pitchers. J Am Acad Orthop Surg. 2015;23(12):789–96.CrossRefGoogle Scholar
  66. 66.
    Myers N, Sciascia A, Westgate PM, Kibler WB, Uhl T. Increasing ball velocity in the overhead athlete: a meta-analysis of randomized controlled trials. J Strength Cond Res. 2015;29(10):2964–79.PubMedCrossRefGoogle Scholar
  67. 67.
    Borstad JD, Ludewig PM. The effect of long versus short pectoralis minor resting length on scapular kinematics in healthy individuals. J Orthop Sports Phys Ther. 2005;35(4):227–38.CrossRefGoogle Scholar
  68. 68.
    Ebaugh DD, McClure PW, Karduna AR. Effects of shoulder muscle fatigue caused by repetitive overhead activities on scapulothoracic and glenohumeral kinematics. J Electromyogr Kinesiol. 2006;16:224–35.PubMedCrossRefGoogle Scholar
  69. 69.
    Moore SD, Uhl TL, Kibler WB. Improvements in shoulder endurance following a baseball-specific strengthening program in high school baseball players. Sports Health. 2013;5(3):233–8.PubMedPubMedCentralCrossRefGoogle Scholar
  70. 70.
    Walton DM, Wideman TH, Sullivan MJL. A Rasch analysis of the pain catastrophizing scale supports its use as an interval-level measure. Clin J Pain. 2013;29:499–506.CrossRefGoogle Scholar
  71. 71.
    Cools AM, Witvrouw EE, DeClercq GA, Danneels LA, Cambier DC. Scapular muscle recruitment pattern: trapezius muscle latency with and without impingement symptoms. Am J Sports Med. 2003;31:542–9.PubMedCrossRefGoogle Scholar
  72. 72.
    Lukasiewicz AC, McClure P, Michener L, Pratt N, Sennett B. Comparison of 3-dimensional scapular position and orientation between subjects with and without shoulder impingement. J Orthop Sports Phys Ther. 1999;29(10):574–86.PubMedCrossRefGoogle Scholar
  73. 73.
    Ludewig PM, Cook TM. Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement. Phys Ther. 2000;80(3):276–91.PubMedGoogle Scholar
  74. 74.
    McKee MD, Pedersen EM, Jones C, Stephen DJG, Kreder HJ, Schemitsch EH, et al. Deficits following nonoperative treatment of displaced midshaft clavicular fractures. J Bone Joint Surg Am. 2006;88:35–40.PubMedGoogle Scholar
  75. 75.
    Kibler WB, Sciascia AD. Kinetic chain contributions to elbow function and dysfunction in sports. Clin Sports Med. 2004;23(4):545–52.PubMedPubMedCentralCrossRefGoogle Scholar
  76. 76.
    Myers JB, Laudner KG, Pasquale MR, Bradley JP, Lephart SM. Glenohumeral range of motion deficits and posterior shoulder tightness in throwers with pathologic internal impingement. Am J Sports Med. 2006;34:385–91.CrossRefGoogle Scholar
  77. 77.
    Mihata T, Jun BJ, Bui CN, Hwang J, McGarry MH, Kinoshita M, et al. Effect of scapular orientation on shoulder internal impingement in a cadaveric model of the cocking phase of throwing. J Bone Joint Surg Am. 2012;94(17):1576–83.CrossRefGoogle Scholar
  78. 78.
    Fedoriw WW, Ramkumar P, McCulloch PC, Lintner DM. Return to play after treatment of superior labral tears in professional baseball players. Am J Sports Med. 2014;42(5):1155–60.CrossRefGoogle Scholar
  79. 79.
    Edwards SL, Lee JA, Bell JE, Packer JD, Ahmad CS, Levine W, et al. Nonoperative treatment of superior labrum anterior posterior tears: improvements in pain, function, and quality of life. Am J Sports Med. 2010;38(7):1456–61.CrossRefGoogle Scholar
  80. 80.
    Sciascia A, Cromwell R. Kinetic chain rehabilitation: a theoretical framework. Rehabil Res Pract. 2012;2012:1–9.Google Scholar
  81. 81.
    Wilk KE, Meister K, Andrews JR. Current concepts in the rehabilitation of the overhead throwing athlete. Am J Sports Med. 2002;30(1):136–51.PubMedPubMedCentralCrossRefGoogle Scholar
  82. 82.
    Buss DD, Lynch GP, Meyer CP, Huber SM, Freehill MQ. Nonoperative management for in-season athletes with anterior shoulder instability. Am J Sports Med. 2004;32(6):1430–3.PubMedCrossRefGoogle Scholar
  83. 83.
    Kibler WB. Management of the scapula in glenohumeral instability. Tech Should Elbow Surg. 2003;4(3):89–98.CrossRefGoogle Scholar
  84. 84.
    Burkhead WZ, Rockwood CA. Treatment of instability of the shoulder with an exercise program. J Bone Joint Surg (Am Vol). 1992;74-A(6):890–6.CrossRefGoogle Scholar
  85. 85.
    Wilk KE, Macrina LC, Reinold MM. Non-operative rehabilitation for traumatic and atraumatic Glenohumeral instability. N Am J Sports Phys Ther. 2006;1(1):16–31.PubMedPubMedCentralGoogle Scholar
  86. 86.
    Burkhead WZ Jr, Rockwood CA Jr. Treatment of instability of the shoulder with an exercise program. J Bone Joint Surg. 1992;74A(6):890–6.CrossRefGoogle Scholar
  87. 87.
    Kuhn JE. Treating the initial anterior shoulder dislocation—an evidence-based medicine approach. Sports Med Arthrosc Rev. 2006;14(4):192–8.PubMedCrossRefGoogle Scholar
  88. 88.
    Gibson K, Growse A, Korda L, Wray E, MacDermid JC. The effectiveness of rehabilitation for Nonoperative Management of shoulder instability: a systematic review. J Hand Ther. 2004;17:229–42.PubMedCrossRefGoogle Scholar
  89. 89.
    Illyes A, Kiss RM. Electromyographic analysis in patients with multidirectional shoulder instability during pull, forward punch, elevation, and overhead throw. Knee Surg Sports Traumatol Arthrosc. 2007;15:624–31.PubMedCrossRefGoogle Scholar
  90. 90.
    Kibler WB, Sciascia A, Wilkes T. Scapular dyskinesis and its relation to shoulder injury. J Am Acad Orthop Surg. 2012;20(6):364–72.CrossRefGoogle Scholar
  91. 91.
    Ellenbecker TS, Cools A. Rehabilitation of shoulder impingement syndrome and rotator cuff injuries: an evidence-based review. Br J Sports Med. 2010;44:319–27.CrossRefGoogle Scholar
  92. 92.
    Mihata T, Gates J, McGarry MH, Lee JC, Kinoshita M, Lee TQ. Effect of rotator cuff muscle imbalance on forceful internal impingement and peel-back of the superior labrum: a cadaveric study. Am J Sports Med. 2009;37(11):2222–7.PubMedCrossRefGoogle Scholar
  93. 93.
    Mihata T, McGarry MH, Kinoshita M, Lee TQ. Excessive glenohumeral horizontal abduction as occurs during the late cocking phase of the throwing motion can be criticial for internal impingement. Am J Sports Med. 2010;38(2):369–82.PubMedCrossRefGoogle Scholar
  94. 94.
    Kuhn JE. Exercise in the treatment of rotator cuff impingement: a systematic review and a synthesized evidence-based rehabilitation protocol. J Shoulder Elb Surg. 2009;18:138–60.CrossRefGoogle Scholar
  95. 95.
    Sciascia A, Karolich D. A comprehensive approach for non-operative treatment of the rotator cuff. Curr Phys Med Rehabil Rep. 2013;1(1):29–37.CrossRefGoogle Scholar
  96. 96.
    Tripp DA, Stanish WD, Reardon G, Coady C, Sullivan MJL. Comparing postoperative pain experiences of the adolescent and adult athlete after anterior cruciate ligament surgery. J Athl Train. 2003;38(2):154–7.PubMedPubMedCentralGoogle Scholar
  97. 97.
    Moradi A, Mellema JJ, Oflazoglu K, Isakov A, Ring D, Vranceanu AM. The relationship between catastrophic thinking and hand diagram areas. J Hand Surg Am. 2015;40(12):2440–6.CrossRefGoogle Scholar
  98. 98.
    Zlowodzki M, Zelle B, Cole PA, Jeray K, McKee MD. Treatment of acute midshaft clavicle fractures: systematic review of 2144 fractures: on behalf of the evidence-based orthopaedic trauma working group. J Orthop Trauma. 2005;19(7):504–7.PubMedCrossRefGoogle Scholar
  99. 99.
    Lazarides S, Zafiropoulos G. Conservative treatment of fractures at the middle third of the clavicle: the relevance of shortening and clinical outcome. J Shoulder Elb Surg. 2006;15(2):191–4.CrossRefGoogle Scholar
  100. 100.
    Ardern CL, Kvist J, Webster KE. Psychological aspects of anterior cruciate ligament injuries. Oper Tech Sports Med. 2016;24(1):77–83.CrossRefGoogle Scholar
  101. 101.
    Kibler WB. Value on the front end: making the effective diagnosis for optimal treatment. Arthroscopy. 2017;33(2):493–5.CrossRefGoogle Scholar
  102. 102.
    Quartana PJ, Campbell CM, Edwards RR. Pain catastrophizing: a critical review. Expert Rev Neurother. 2009;9(5):745–58.PubMedPubMedCentralCrossRefGoogle Scholar
  103. 103.
    Wilk KE, Macrina LC, Fleisig GS, Aune KT, Porterfield RA, Harker P, et al. Deficits in glenohumeral passive range of motion increase risk of shoulder injury in professional baseball pitchers: a prospective study. Am J Sports Med. 2015;43(10):2379–85.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • W. Ben Kibler
    • 1
  • Stephen J. Thomas
    • 2
  • Aaron D. Sciascia
    • 3
    Email author
  1. 1.Shoulder Center of KentuckyLexington ClinicLexingtonUSA
  2. 2.Temple University, Department of KinesiologyPhiladelphiaUSA
  3. 3.Eastern Kentucky University, Department of Exercise and Sport ScienceRichmondUSA

Personalised recommendations