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Shoulder Injuries in Handball

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Handball Sports Medicine

Abstract

Shoulder injuries are frequent in handball. They can affect performance and even be career compromising for some players. The shoulder represents between 4 and 27% of all handball injuries. The majority of shoulder injuries in handball are caused by repetitive overhead activities leading to overuse injuries rather than by single traumatic mechanism. There is still controversy about the biomechanics and the underlying pathology of the shoulder injuries. Consistent throwing movements can cause multiple changes involving bony and soft-tissue adaptations resulting in increased glenohumeral external rotation and limited internal rotation, and potentially leading to internal impingement, rotator cuff tears and labral labal tears (posterior and anterior labrum, superior labrum anterior to posterior (SLAP) tears) with scapular dyskinesis.

Any weakness or imbalance that alters the components of the kinetic chain, especially in the lower legs and the trunk, can lead to a dysfunctional shoulder and ultimately to a potential risk for upper extremity injuries. A general comprehension of the throwing dynamics and the kinematics of each technique’s phase is crucial for the clinician monitoring these athletes.

Players usually complain of pain but can sometimes report unexplained loss of throwing velocity and throwing control. Although laxity findings are relatively common in shoulders of handball players, instability complaints are less frequent, and their significance is yet unclear and controversial.

The spectrum of MRI findings in shoulders of handball players includes partial rotator cuff tears and tendinopathy, degeneration and tearing of the posterosuperior glenoid labrum, superolateral humeral head defects cysts and oedema, SLAP lesions and sometimes anteroinferior labrum abnormality. Prudence must be made in the interpretation of these abnormalities, and the therapeutic decision-making, especially surgical, must not rely only on the imaging assessment.

Due to the nature of shoulder injuries in handball players, conservative treatment must be primarily considered after an accurate and thorough evaluation of the complaint and symptoms of the patient. A phased progression of rehabilitation has been suggested for the nonoperative management of shoulder injuries in handball players.

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References

  1. Meister K, Buckley B, Batts J. The posterior impingement sign: diagnosis of rotator cuff and posterior labral tears secondary to internal impingement in overhand athletes. Am J Orthop (Belle Mead NJ). 2004;33:412–5.

    Google Scholar 

  2. Kibler WB, Kuhn JE, Wilk K, Sciascia A, Moore S, Laudner K, Ellenbecker T, Thigpen C, Uhl T. The disabled throwing shoulder: spectrum of pathology-10-year update. Arthroscopy. 2013;29:141–61.

    Article  Google Scholar 

  3. Meyer KE, Saether EE, Soiney EK, Shebeck MS, Paddock KL, Ludewig PM. Three-dimensional scapular kinematics during the throwing motion. J Appl Biomech. 2008;24:24–34.

    Article  Google Scholar 

  4. Weber AE, Kontaxis A, O’Brien SJ, Bedi A. The biomechanics of throwing: simplified and cogent. Sports Med Arthrosc Rev. 2014;22:72–9.

    Article  Google Scholar 

  5. Bere T, Alonso JM, Wangensteen A, Bakken A, Eirale C, Dijkstra HP, Ahmed H, Bahr R, Popovic N. Injury and illness surveillance during the 24th Men’s Handball World Championship 2015 in Qatar. Br J Sports Med. 2015;49:1151–6.

    Article  Google Scholar 

  6. Giroto N, Hespanhol Junior LC, Gomes MR, Lopes AD. Incidence and risk factors of injuries in Brazilian elite handball players: a prospective cohort study. Scand J Med Sci Sports. 2017;27:195–202.

    Article  CAS  Google Scholar 

  7. Langevoort G, Myklebust G, Dvorak J, Junge A. Handball injuries during major international tournaments. Scand J Med Sci Sports. 2007;17:400–7.

    CAS  Google Scholar 

  8. Olsen OE, Myklebust G, Engebretsen L, Bahr R. Injury pattern in youth team handball: a comparison of two prospective registration methods. Scand J Med Sci Sports. 2006;16:426–32.

    Article  Google Scholar 

  9. Seil R, Rupp S, Tempelhof S, Kohn D. Sports injuries in team handball. A one-year prospective study of sixteen men’s senior teams of a superior nonprofessional level. Am J Sports Med. 1998;26:681–7.

    Article  CAS  Google Scholar 

  10. Laver L, Myklebust G. Epidemiology and injury characterization. In: Doral MN, Karlsson J, editors. Sports injuries: prevention, diagnosis, treatment and rehabilitation. Berlin: Springer; 2014. p. 1–27.

    Google Scholar 

  11. Myklebust G, Hasslan L, Bahr R, Steffen K. High prevalence of shoulder pain among elite Norwegian female handball players. Scand J Med Sci Sports. 2011;23:288–94.

    Article  Google Scholar 

  12. Gohlke F, Lippert MJ, Keck O. Instability and impingement of the shoulder of the high performance athlete in overhead stress. Sportverletz Sportschaden. 1993;7:115–21.

    Article  CAS  Google Scholar 

  13. Clarsen B, Bahr R, Andersson SH, Munk R, Myklebust G. Reduced glenohumeral rotation, external rotation weakness and scapular dyskinesis are risk factors for shoulder injuries among elite male handball players: a prospective cohort study. Br J Sports Med. 2014;48:1327–33.

    Article  Google Scholar 

  14. Lubiatowski P, Kaczmarek P, Cisowski P, Breborowicz E, Grygorowicz M, Dzianach M, Krupecki T, Laver L, Romanowski L. Rotational glenohumeral adaptations are associated with shoulder pathology in professional male handball players. Knee Surg Sports Traumatol Arthrosc. 2017;26(1):67–75. https://doi.org/10.1007/s00167-017-4426-9.

    Article  PubMed  Google Scholar 

  15. Fieseler G, Jungermann P, Koke A, Irlenbusch L, Delank KS, Schwesig R. Range of motion and isometric strength of shoulder joints of team handball athletes during the playing season, Part II: changes after midseason. J Shoulder Elb Surg. 2015;24:391–8.

    Article  Google Scholar 

  16. Fleisig GS, Andrews JR, Dillman CJ, et al. Kinetics of baseball pitching with implications about injury mechanisms. Am J Sports Med. 1995;23:233–9.

    Article  CAS  Google Scholar 

  17. Kinsella SD, Thomas SJ, Huffman GR, Kelly JD 4th. The thrower’s shoulder. Orthop Clin North Am. 2014;45:387–401.

    Article  Google Scholar 

  18. Sabick MB, Kim YK, Torry MR, Keirns MA, Hawkins RJ. Biomechanics of the shoulder in youth baseball pitchers: implications for the development of proximal humeral epiphysiolysis and humeral retrotorsion. Am J Sports Med. 2005;33:1716–22.

    Article  Google Scholar 

  19. Braun S, Kokmeyer D, Millett PJ. Shoulder injuries in the throwing athlete. J Bone Joint Surg Am. 2009;91:966–78.

    Article  Google Scholar 

  20. Kibler WB, Sciascia A. The role of the scapula in preventing and treating shoulder instability. Knee Surg Sports Traumatol Arthrosc. 2016;24:390–7.

    Article  Google Scholar 

  21. David G, Magarey ME, Jones MA, Dvir Z, Türker KS, Sharpe M. EMG and strength correlates of selected shoulder muscles during rotations of the glenohumeral joint. Clin Biomech (Bristol, Avon). 2000;15:95–102.

    Article  CAS  Google Scholar 

  22. Whiteley R, Ginn K, Nicholson L, Adams R. Indirect ultrasound measurement of humeral torsion in adolescent baseball players and non-athletic adults: reliability and significance. J Sci Med Sport. 2006;9:310–8.

    Article  Google Scholar 

  23. Osbahr DC, Cannon DL, Speer KP. Retroversion of the humerus in the throwing shoulder of college baseball pitchers. Am J Sports Med. 2002;30:347–53.

    Article  Google Scholar 

  24. Reagan KM, Meister K, Horodyski MB, Werner DW, Carruthers C, Wilk K. Humeral retroversion and its relationship to glenohumeral rotation in the shoulder of college baseball players. Am J Sports Med. 2002;30:354–60.

    Article  CAS  Google Scholar 

  25. Pieper HG. Humeral torsion in the throwing arm of handball players. Am J Sports Med. 1998;26:247–53.

    Article  CAS  Google Scholar 

  26. Chambers L, Altchek DW. Microinstability and internal impingement in overhead athletes. Clin Sports Med. 2013;32:697–707.

    Article  Google Scholar 

  27. Kuhn JE, Huston LJ, Soslowsky LJ, Shyr Y, Blasier RB. External rotation of the glenohumeral joint: ligament restraints and muscle effects in the neutral and abducted positions. J Shoulder Elb Surg. 2005;14(1 Suppl S):39S–48S.

    Article  Google Scholar 

  28. Noffal GJ. Isokinetic eccentric-to-concentric strength ratios of the shoulder rotator muscles in throwers and nonthrowers. Am J Sports Med. 2003;31:537–41.

    Article  Google Scholar 

  29. Wilk KE, Meister K, Andrews JR. Current concepts in the rehabilitation of the overhead throwing athlete. Am J Sports Med. 2002;30:136–51.

    Article  Google Scholar 

  30. Møller M, Nielsen RO, Attermann J, Wedderkopp N, Lind M, Sørensen H, Myklebust G. Handball load and shoulder injury rate: a 31-week cohort study of 679 elite youth handball players. Br J Sports Med. 2017;51:231–7.

    Article  Google Scholar 

  31. Winter SB, Hawkins RJ. Comprehensive history and physical examination of the throwing shoulder. Sports Med Arthrosc Rev. 2014;22:94–100.

    Article  Google Scholar 

  32. Kibler WB, McMullen J. Scapular dyskinesis and its relation to shoulder pain. J Am Acad Orthop Surg. 2003;11:142–51.

    Article  Google Scholar 

  33. Freedman L, Munro RR. Abduction of the arm in the scapular plane: scapular and glenohumeral movements. A roentgenographic study. J Bone Joint Surg Am. 1966;48:1503–10.

    Article  CAS  Google Scholar 

  34. 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;19:641–61.

    Article  Google Scholar 

  35. Tokish JM, Curtin MS, Kim YK, Hawkins RJ, Torry MR. Glenohumeral internal rotation deficit in the asymptomatic professional pitcher and its relationship to humeral retroversion. J Sports Sci Med. 2008;1(7):78–83.

    Google Scholar 

  36. Almeida GP, Silveira PF, Rosseto NP, Barbosa G, Ejnisman B, Cohen M. Glenohumeral range of motion in handball players with and without throwing-related shoulder pain. J Shoulder Elb Surg. 2013;22:602–7.

    Article  Google Scholar 

  37. Andersson SH, Bahr R, Clarsen B, Myklebust G. Risk factors for overuse shoulder injuries in a mixed-sex cohort of 329 elite handball players: previous findings could not be confirmed. Br J Sports Med. 2017a.

    Google Scholar 

  38. Gerber C, Krushell RJ. Isolated rupture of the tendon of the subscapularis muscle. Clinical features in 16 cases. J Bone Joint Surg Br. 1991;73:389–94.

    Article  CAS  Google Scholar 

  39. Barth JR, Burkhart SS, De Beer JF. The bear-hug test: a new and sensitive test for diagnosing a subscapularis tear. Arthroscopy. 2006;22:1076–84.

    Article  Google Scholar 

  40. Caliş M, Akgün K, Birtane M, Karacan I, Caliş H, Tüzün F. Diagnostic values of clinical diagnostic tests in subacromial impingement syndrome. Ann Rheum Dis. 2000;59:44–7.

    Article  Google Scholar 

  41. Martetschläger F, Rios D, Boykin RE, Giphart JE, de Waha A, Millett PJ. Coracoid impingement: current concepts. Knee Surg Sports Traumatol Arthrosc. 2012;20:2148–55.

    Article  Google Scholar 

  42. 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.

    Article  CAS  Google Scholar 

  43. O’Brien SJ, Pagnani MJ, Fealy S, McGlynn SR, Wilson JB. The active compression test: a new and effective test for diagnosing labral tears and acromioclavicular joint abnormality. Am J Sports Med. 1998;26:610–3.

    Article  Google Scholar 

  44. Kibler WB. Specificity and sensitivity of the anterior slide test in throwing athletes with superior glenoid labral tears. Arthroscopy. 1995;11:296–300.

    Article  CAS  Google Scholar 

  45. Parentis MA, Glousman RE, Mohr KS, Yocum LA. An evaluation of the provocative tests for superior labral anterior posterior lesions. Am J Sports Med. 2006;34:265–8.

    Article  Google Scholar 

  46. Rosas S, Krill MK, Amoo-Achampong K, Kwon K, Nwachukwu BU, McCormick F. A practical, evidence-based, comprehensive (PEC) physical examination for diagnosing pathology of the long head of the biceps. J Shoulder Elb Surg. 2017;26:1484–92.

    Article  Google Scholar 

  47. Bennett WF. Specificity of the Speed’s test: arthroscopic technique for evaluating the biceps tendon at the level of the bicipital groove. Arthroscopy. 1998;14:789–96.

    Article  CAS  Google Scholar 

  48. Jost B, Zumstein M, Pfirrmann CW, Zanetti M, Gerber C. MRI findings in throwing shoulders: abnormalities in professional handball players. Clin Orthop Relat Res. 2005;434:130–7.

    Article  Google Scholar 

  49. Ferrari JD, Ferrari DA, Coumas J, Pappas AM. Posterior ossification of the shoulder: the Bennett lesion. Etiology, diagnosis, and treatment. Am J Sports Med. 1994;22:171–5.

    Article  CAS  Google Scholar 

  50. Walch G, Boileau P, Noel E, Donell ST. Impingement of the deep surface of the supraspinatus tendon on the posterosuperior glenoid rim: an arthroscopic study. J Shoulder Elb Surg. 1992;1:238–45.

    Article  CAS  Google Scholar 

  51. Ellenbecker TS, Mattalino AJ. Concentric isokinetic shoulder internal and external rotation strength in professional baseball pitchers. J Orthop Sports Phys Ther. 1997;25:323–8.

    Article  CAS  Google Scholar 

  52. Jobe FW, Kvitne RS, Giangarra CE. Shoulder pain in the overhand or throwing athlete. The relationship of anterior instability and rotator cuff impingement. Orthop Rev. 1989;18:963–75.

    CAS  PubMed  Google Scholar 

  53. Halbrecht JL, Tirman P, Atkin D. Internal impingement of the shoulder: comparison of findings between the throwing and nonthrowing shoulders of college baseball players. Arthroscopy. 1999;15:253–8.

    Article  CAS  Google Scholar 

  54. Lo IK, Burkhart SS. Transtendon arthroscopic repair of partial-thickness, articular surface tears of the rotator cuff. Arthroscopy. 2004;20:214–20.

    Article  Google Scholar 

  55. Rudzki JR, Shaffer B. New approaches to diagnosis and arthroscopic management of partial-thickness cuff tears. Clin Sports Med. 2008;27:691–717.

    Article  CAS  Google Scholar 

  56. Payne LZ, Altchek DW, Craig EV, Warren RF. Arthroscopic treatment of partial rotator cuff tears in young athletes. A preliminary report. Am J Sports Med. 1997;25:299–305.

    Article  CAS  Google Scholar 

  57. Tibone JE, Elrod B, Jobe FW, Kerlan RK, Carter VS, Shields CL Jr, Lombardo SJ, Yocum L. Surgical treatment of tears of the rotator cuff in athletes. J Bone Joint Surg Am. 1986;68:887–91.

    Article  CAS  Google Scholar 

  58. Snyder SJ, Karzel RP, Del Pizzo W, Ferkel RD, Friedman MJ. SLAP lesions of the shoulder. Arthroscopy. 1990;6:274–9.

    Article  CAS  Google Scholar 

  59. Boileau P, Parratte S, Chuinard C, Roussanne Y, Shia D, Bicknell R. Arthroscopic treatment of isolated type II SLAP lesions: biceps tenodesis as an alternative to reinsertion. Am J Sports Med. 2009;37:929–36.

    Article  Google Scholar 

  60. Schrøder CP, Skare Ø, Reikerås O, Mowinckel P, Brox JI. Sham surgery versus labral repair or biceps tenodesis for type II SLAP lesions of the shoulder: a three-armed randomised clinical trial. Br J Sports Med. 2017;51(24):1759–66. https://doi.org/10.1136/bjsports-2016-097098.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Burn MB, McCulloch PC, Lintner DM, Liberman SR, Harris JD. Prevalence of scapular dyskinesis in overhead and nonoverhead athletes: a systematic review. Orthop J Sports Med. 2016;4(2).

    Article  Google Scholar 

  62. Priest JD, Nagel DA. Tennis shoulder. Am J Sports Med. 1976;4:28–42.

    CAS  PubMed  Google Scholar 

  63. Lehtinen JT, Tetreault P, Warner JJ. Arthroscopic management of painful and stiff scapulothoracic articulation. Arthroscopy. 2003;19:E28.

    Article  Google Scholar 

  64. Struyf F, Nijs J, Meeus M, Roussel NA, Mottram S, Truijen S, Meeusen R. Does scapular positioning predict shoulder pain in recreational overhead athletes? Int J Sports Med. 2014;35:75–82.

    CAS  PubMed  Google Scholar 

  65. Mlynarek RA, Lee S, Bedi A. Shoulder injuries in the overhead throwing athlete. Hand Clin. 2017;33:19–34.

    Article  Google Scholar 

  66. Andersson SH, Bahr R, Clarsen B, Myklebust G. Preventing overuse shoulder injuries among throwing athletes: a cluster-randomised controlled trial in 660 elite handball players. Br J Sports Med. 2017b;51:1073–80.

    Article  Google Scholar 

  67. Nicholson GP, Duckworth MA. Scapulothoracic bursectomy for snapping scapula syndrome. J Shoulder Elb Surg. 2002;11:80–5.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Aspetar - Orthopaedic and Sports Medicine Hospital, Doha, Qatar

    Philippe Landreau

  2. Department of Orthopaedics and Traumatology, Shoulder, Elbow and Sports Medicine, University of Bern, Bern, Switzerland

    Matthias A. Zumstein

  3. SportsClinic, #1 AG, Wankdorf Center, Bern, Switzerland

    Matthias A. Zumstein

  4. Sport Trauma and Biomechanics Unit, University of Medical Sciences, Poznań, Poland

    Przemyslaw Lubiatowski

  5. Rehasport Clinic, Poznań, Poland

    Przemyslaw Lubiatowski

  6. Department of Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire, Coventry, UK

    Lior Laver

  7. Department of Arthroscopy, Royal Orthopaedic Hospital, Birmingham, UK

    Lior Laver

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  1. Philippe Landreau
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  2. Matthias A. Zumstein
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  3. Przemyslaw Lubiatowski
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  4. Lior Laver
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Correspondence to Philippe Landreau .

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Editors and Affiliations

  1. Department of Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom

    Lior Laver

  2. Department of Surgery, Aspetar - Orthopaedic and Sports Medicine Hospital, Doha, Qatar

    Philippe Landreau

  3. Clinique d’Eich, Centre Hospitalier de Luxembourg Clinique d’Eich, Luxembourg, Luxembourg

    Romain Seil

  4. Aspetar - Orthopaedic and Sports Medicine Hospital, Weill Cornell Medical College, Doha, Qatar

    Nebojsa Popovic

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Landreau, P., Zumstein, M.A., Lubiatowski, P., Laver, L. (2018). Shoulder Injuries in Handball. In: Laver, L., Landreau, P., Seil, R., Popovic, N. (eds) Handball Sports Medicine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-55892-8_14

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