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The Overhead Athlete

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Shoulder Arthroscopy

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Abstract

The term “disabled throwing shoulder” (DTS) is a general term that describes the limitations of function that exist in symptomatic overhead athletes in that they cannot optimally perform the task of throwing, hitting, or striking the ball. In the large percentage of cases, the DTS is the result of a “cascade to injury”, a process in which the body’s response to the inherent demands of throwing, hitting, or striking results in a series of alterations throughout the kinetic chain which can affect the optimal function of all segments in the chain. These alterations of function, termed dysfunctions, can have anatomical, physiological, and/or biomechanical causative factors.

Anatomic factors include labral, biceps, and rotator cuff injury. Physiologic factors include muscle strength weakness, imbalance, and inflexibility and alterations in all aspects of glenohumeral range of motion—internal rotation, external rotation, and total range of motion. Biomechanical factors include kinetic chain deficits, scapular dyskinesis, and alterations in the mechanics of the overhead motion.

Very rarely will one specific anatomic injury or physiologic alteration be present by itself or be responsible for all disabling symptoms. More commonly, several will be found, and act together to create the total dysfunction. The athlete with the DTS must be evaluated for all of the possible factors to arrive at a complete and accurate diagnosis. This comprehensive approach will facilitate optimum operative and nonoperative treatment protocols and serve as a baseline for functional outcomes assessment, which will then guide optimum rehabilitation. The rehabilitation program should be progressive and sequential through three specific stages or phases based on the level of disability and tissue irritability that exist and should be inclusive enough to address the most common deficits discovered on the exam. Specific rehabilitation programs focused on restoration of all the altered factors are required to produce optimal results.

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Acknowledgment

The current chapter is an update of the one published in the previous edition and authored by W. Ben Kibler, John E. Kuhn, Aaron D. Sciascia, and Tim L. Uhl.

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Authors and Affiliations

  1. Shoulder Center of Kentucky, Lexington Clinic, Lexington, KY, USA

    W. Ben Kibler

  2. Institute for Clinical Outcomes and Research, Lexington Clinic, South Broadway, Lexington, KY, USA

    Aaron Sciascia

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Correspondence to Aaron Sciascia .

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Editors and Affiliations

  1. Department of Joint and Bone Surgery, University of Brescia, Brescia, Brescia, Italy

    Giuseppe Milano

  2. Department of Orthopaedics and Traumatology, Casa di Cura Villa Valeria, Rome, Roma, Italy

    Andrea Grasso

  3. Shoulder and Upper Limb Department, St. Luke's Hospital, Bielsko-Biała, Poland

    Roman Brzóska

  4. Department of Traumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia

    Ladislav Kovačič

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Kibler, W.B., Sciascia, A. (2023). The Overhead Athlete. In: Milano, G., Grasso, A., Brzóska, R., Kovačič, L. (eds) Shoulder Arthroscopy. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-66868-9_31

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