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The Disabled Throwing Shoulder: When and How to Operate

  • Nuno Gomes
  • Ricardo Aido
  • Joana Gomes
Chapter

Abstract

The throwing athletes provide a demanding challenge to the orthopedic surgeon. The repetitive overhead motion they are subjected places high forces on the shoulder, predisposing them to injuries. However, these pathologic changes do not necessarily have a clinical expression, and several factors may contribute to turn these asymptomatic shoulders into symptomatic.

A conservative approach is the mainstay of the treatment of a disabled throwing shoulder, and familiarity with the rehabilitation principles of this clinical entity by the physicians, namely, the orthopedic surgeon, is mandatory to be able to identify where the treatment should focus and avoid unnecessary or unsuccessful surgical interventions. Decision to operate on a thrower’s shoulder must only take place after exhausting the conservative alternatives.

Keywords

Overhead athlete Throwing shoulder Biceps SLAP Scapular dyskinesis 

References

  1. 1.
    Wilk KE, Arrigo C. Current concepts in the rehabilitation of the athletic shoulder. J Orthop Sports Phys Ther. 1993;18(1):365–78.CrossRefGoogle Scholar
  2. 2.
    Lauchlan Chambers L, Altchek DW. Microinstability and internal impingement in overhead athletes. Clin Sports Med. 2013;32:697–707.CrossRefGoogle Scholar
  3. 3.
    Braun S, Kokmeyer D, Millett PJ. Shoulder injuries in the throwing athlete. J Bone Joint Surg Am. 2009;91(4):966–78.CrossRefGoogle Scholar
  4. 4.
    Kurokawa D, Yamamoto N, Ishikawa H, Nagamoto H, Takahashi H, Muraki T, Tanaka M, Sato K, Itoi E. Differences in humeral retroversion in dominant and nondominant sides of young baseball players. J Shoulder Elb Surg. 2017;26(6):1083–7.  https://doi.org/10.1016/j.jse.2016.11.051. [Epub ahead of print].CrossRefGoogle Scholar
  5. 5.
    Park SS, Loebenberg ML, Rokito AS, et al. The shoulder in baseball pitching: biomechanics and related injuries—part 1. Bull Hosp Jt Dis. 2002;61(1–2):68–79.PubMedGoogle Scholar
  6. 6.
    Park SS, Loebenberg ML, Rokito AS, et al. The shoulder in baseball pitching: biomechanics and related injuries—part 2. Bull Hosp Jt Dis. 2002;61(1–2):80–8.PubMedGoogle Scholar
  7. 7.
    Malicky DM, Kuhn JE, Frisancho JC, et al. Nonrecoverable strain fields of the anteroinferior glenohumeral capsule under subluxation. J Shoulder Elb Surg. 2002;11:529–40.CrossRefGoogle Scholar
  8. 8.
    Jobe CM. Posterior superior glenoid impingement: expanded spectrum. Arthroscopy. 1995;11(5):530–6.CrossRefGoogle Scholar
  9. 9.
    Wilk KE, Arrigo CA, Andrews JR. Current concepts: the stabilizing structures of the glenohumeral joint. J Orthop Sports Phys Ther. 1997;25(6):364–79.CrossRefGoogle Scholar
  10. 10.
    Burkhart SS, Morgan CD. The peel-back mechanism: its role in producing and extending posterior type II SLAP lesions and its effect on SLAP repair rehabilitation. Arthroscopy. 1998;14:637–40.CrossRefGoogle Scholar
  11. 11.
    Kibler WB, Kuhn JE, Wilk K, Sciascia A, Moore S, Laudner K, Ellenbecker T, Thigpen C, Tim Uhl T. The disabled throwing shoulder: spectrum of pathology – 10 year update. Arthroscopy. 2013;29(1):141–61.CrossRefGoogle Scholar
  12. 12.
    Davids K, Glazier P, Araújo D, Bartlett R. Movement systems as dynamical systems: the functional role of variability and its implications for sports medicine. Sports Med. 2003;33:245–60.CrossRefGoogle Scholar
  13. 13.
    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
  14. 14.
    Robb AJ, Fleisig G, Wilk K, Macrina L, Bolt B, Pajaczkowski J. Passive ranges of motion of the hips and their relationship with pitching biomechanics and ball velocity in professional baseball pitchers. Am J Sports Med. 2010;38:2487–93.CrossRefGoogle 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;33:263–71.CrossRefGoogle Scholar
  16. 16.
    Ludewig PM, Reynolds JF. The association of scapular kinematics and glenohumeral joint pathologies. J Orthop Sport Phys Ther. 2009;39:90–104.CrossRefGoogle Scholar
  17. 17.
    Burkhart SS, Morgan CD, Ben 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
  18. 18.
    Laudner KG, Myers JB, Pasquale MR, et al. Scapular dysfunction in throwers with pathologic internal impingement. J Orthop Sports Phys Ther. 2006;36(7):485–94.CrossRefGoogle Scholar
  19. 19.
    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
  20. 20.
    Kibler WB. Rehabilitation of rotator cuff tendinopathy. Clin Sports Med. 2003;22:837–48. Arthroscopy (2003);19(6):641-661.CrossRefGoogle Scholar
  21. 21.
    Brabston EW, Galdi B, Ciccone J, Yenchak A, Ahmad CS. The thrower’s shoulder: an update. JBJS Rev. 2015;3(4):e4.CrossRefGoogle Scholar
  22. 22.
    Wilk KE, Macrina LC, Fleisig GS, et al. Correlation of glenohumeral internal rotation deficit and total rotational motion to shoulder injuries in professional baseball pitchers. Am J Sports Med. 2011;39(2):329–35.CrossRefGoogle Scholar
  23. 23.
    Wilk KE, Macrina LC, Fleisig GS, Aune KT, Porterfield RA, Harker P, Evans TJ, Andrews JR. 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
  24. 24.
    Connor PM, Banks DM, Tyson AB, Coumas JS, D’Alessandro DF. Magnetic resonance imaging of the asymptomatic shoulder of overhead athletes: a 5- year follow-up study. Am J Sports Med. 2003;31:724–7.CrossRefGoogle Scholar
  25. 25.
    Burkhart SS, Morgan C. SLAP lesions in the overhead athlete. Orthop Clin North Am. 2001;32(3):431–41, viii.CrossRefGoogle Scholar
  26. 26.
    Cohn RM, Jazrawi LM. The throwing shoulder: the orthopedist perspective. Magn Reson Imaging Clin N Am. 2012;20:261–75.CrossRefGoogle Scholar
  27. 27.
    Nakagawa S, Yoneda M, Hayashida K, Mizuno N, Yamada S. Posterior shoulder pain in throwing athletes with a Bennett lesion: factors that influence throwing pain. J Shoulder Elb Surg. 2006;15(1):72–7.CrossRefGoogle Scholar
  28. 28.
    Gomes N. Exame Clínico. In: Ombro O, editor. Lidel; 2009. pp. 29–50.Google Scholar
  29. 29.
    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.CrossRefGoogle Scholar
  30. 30.
    Sciascia A, Myers N, Kibler WB, Uhl TL. Return to preinjury levels of participation after superior labral repair in overhead athletes: a systematic review. J Athl Train. 2015;50(7):767–77.CrossRefGoogle Scholar
  31. 31.
    Harris JD, Frank JM, Jordan MA, Bush-Joseph CA, Romeo AA, Gupta AK, Abrams GD, McCormick FM, Bach BR Jr. Return to sport following shoulder surgery in the elite pitcher: a systematic review. Sports Health. 2013;5(4):367–76.CrossRefGoogle Scholar
  32. 32.
    Brand H, van der Linde JA, van Deurzen DFP, van den Bekerom MPJ. Lacking evidence for rehabilitation following arthroscopic Bankart repair: a systematic review. J ISAKOS. 2017;2(1):14–20.CrossRefGoogle Scholar
  33. 33.
    Boileau P, Parratte S, Chuinard C, Roussanne Y, Shia D, Bicknell R. Arthroscopic treatment of isolated type II SLAP lesions. Am J Sports Med. 2009;37(5):929–36.Google Scholar
  34. 34.
    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. Epub 2014 Mar 27.CrossRefGoogle Scholar
  35. 35.
    Moore-Reed SD, Kibler WB, Sciascia AD, Uhl T. Preliminary development of a clinical prediction rule for treatment of patients with suspected SLAP tears. Arthroscopy. 2014;30(12):1540–9.CrossRefGoogle Scholar
  36. 36.
    Patterson BM, Creighton RA, Spang JT, Roberson JR, Kamath GV. Surgical trends in the treatment of superior Labrum anterior and posterior lesions of the shoulder. Am J Sports Med. 2014;42(8):1904–10.CrossRefGoogle Scholar
  37. 37.
    Ek ET, Shi LL, Tompson JD, Freehill MT, Warner JJ. Surgical treatment of isolated type II superior labrum anterior-posterior (SLAP) lesions: repair versus biceps tenodesis. J Shoulder Elb Surg. 2014;23(7):1059–65.CrossRefGoogle Scholar
  38. 38.
    Yoo JC, Ahn JH, Lee SH, Lim HC, Choi KW, Bae TS, Lee CY. A biomechanical comparison of repair techniques in posterior type II superior labral anterior and posterior (SLAP) lesions. J Shoulder Elb Surg. 2008;17(1):144–9.CrossRefGoogle Scholar
  39. 39.
    Morgan RJ, Kuremsky MA, Peindl RD, Fleischli JE. A biomechanical comparison of two suture anchor configurations for the repair of type II SLAP lesions subjected to a peel-back mechanism of failure. Arthroscopy. 2008;24(4):383–8.CrossRefGoogle Scholar
  40. 40.
    Friedman JL, FitzPatrick JL, Rylander LS, Bennett C, Vidal AF, McCarty EC. Biceps Tenotomy versus Tenodesis in active patients younger than 55 years: is there a difference in strength and outcomes? Orthop J Sports Med. 2015;3(2):2325967115570848.CrossRefGoogle Scholar
  41. 41.
    Moon SC, Cho NS, Rhee YG. Analysis of “hidden lesions” of the extra-articular biceps after subpectoral biceps Tenodesis: the subpectoral portion as the optimal Tenodesis site. Am J Sports Med. 2015;43:63–8.CrossRefGoogle Scholar
  42. 42.
    Sears BW, Spencer EE, Getz CL. Humeral fracture following subpectoral biceps tenodesis in 2 active, healthy patients. J Shoulder Elb Surg. 2011;20(6):e7–11.CrossRefGoogle Scholar
  43. 43.
    Beason DP, Shah JP, Duckett JW, Jost PW, Fleisig GS, Cain EL Jr. Torsional fracture of the humerus after subpectoral biceps Tenodesis with an interference screw: a biomechanical cadaveric study. Clin Biomech (Bristol, Avon). 2015;30(9):915–20.CrossRefGoogle Scholar
  44. 44.
    Gomes N, Silva MR, Pereira H, Aido R, Sampaio R. Long biceps subpectoral Tenodesis with suspensory button and bicortical fixation. Arthrosc Tech. 2017;6(4):e1049–55.CrossRefGoogle Scholar
  45. 45.
    Van Kleunen JP, Tucker SA, Field LD, Savoie FH. Return to high-level throwing after combination infraspinatus repair, SLAP repair, and release of glenohumeral internal rotation deficit. Am J Sports Med. 2012;40(11):2536–41. Epub 2012 Oct 10.CrossRefGoogle Scholar
  46. 46.
    Ide J, Maeda S, Takagi K. Arthroscopic transtendon repair of partial-thickness articular-side tears of the rotator cuff: anatomical and clinical study. Am J Sports Med. 2005;33(11):1672–9. Epub 2005 Aug 10.CrossRefGoogle Scholar
  47. 47.
    Liem D, Lichtenberg S, Magosch P, Habermeyer P. Arthroscopic rotator cuff repair in overhead-throwing athletes. Am J Sports Med. 2008;36(7):1317–22. Epub 2008 Apr 28.CrossRefGoogle Scholar
  48. 48.
    Mazoue CG, Andrews JR. Repair of full- thickness rotator cuff tears in professional baseball players. Am J Sports Med. 2006;34(2):182–9. Epub 2005 Oct 31.CrossRefGoogle Scholar
  49. 49.
    Shaffer B, Huttman D. Rotator cuff tears in the throwing athlete. Sports Med Arthrosc Rev. 2014;22(2):101–9.CrossRefGoogle Scholar
  50. 50.
    Kuhn JE. Current concepts: rotator cuff pathology in athletes—a source of pain or adaptive pathology? Curr Sports Med Rep. 2013;12(5):311–5.CrossRefGoogle Scholar
  51. 51.
    Castagna A, Borroni M, Garofalo R, Rose GD, Cesari E, Padua R, Conti M, Gumina S. Deep partial rotator cuff tear: transtendon repair or tear completion and repair? A randomized clinical trial. Knee Surg Sports Traumatol Arthrosc. 2015;23(2):460–3.CrossRefGoogle Scholar

Copyright information

© ESSKA 2018

Authors and Affiliations

  • Nuno Gomes
    • 1
    • 2
  • Ricardo Aido
    • 3
  • Joana Gomes
    • 4
  1. 1.Hospital Forças Armadas - Polo do PortoPortoPortugal
  2. 2.Hospital da Luz ArrábidaPortoPortugal
  3. 3.Centro Hospitalar Póvoa de Varzim – Vila do CondePóvoa de VarzimPortugal
  4. 4.Hospital Srª da OliveiraGuimarãesPortugal

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