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The Sports Medicine Physician pp 307–316Cite as

Shoulder: The Thrower’s Shoulder

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Abstract

The specific motion pattern in overhead and throwing sports results in high stress to the athlete’s shoulder and therefore shows a higher incidence of long-term overload damage. In combination with a repetitive distention of the anterior capsule, the shortening of the dorsal capsular structures leads to a decentralization and posterosuperior translation of the humeral head. Due to the contact of the articular-sided insertion of supraspinatus and infraspinatus tendon and the posterosuperior glenoid rim, a PSI develops. Finally, rotator cuff tears as well as lesions of the biceps anchor complex and pulley system occur. Based on clinical examination and imaging, the five-point check for the athlete’s shoulder was developed, including joint capsule, scapula, joint stability, rotator cuff and biceps tendon complex. Conservative therapy is based on a graded rehabilitation programme including training of the complete kinetic chain, joint mobility, strength, endurance and neuromuscular control. A GIRD should be addressed by stretching, whereas a scapula dyskinesia requires intensive strengthening of the periscapular muscles. Surgical treatment includes SLAP repair, subpectoral biceps tenodesis or refixation of rotator cuff tears to the original footprint.

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References

  1. Beitzel K, Beitzel KI, Zandt JF, Buchmann S, Schwirtz A, Imhoff AB, Reiser M, Brucker PU. Premature cystic lesions in shoulders of elite junior javelin and volleyball athletes: a comparative evaluation using 3.0 Tesla MRI. J Shoulder Elbow Surg. 2013;22(6):792–9.

    Article  Google Scholar 

  2. Beitzel K, Zandt JF, Buchmann S, Beitzel KI, Schwirtz A, Imhoff AB, Brucker PU. Structural and biomechanical changes in shoulders of junior javelin throwers: a comprehensive evaluation as a proof of concept for a preventive exercise protocol. Knee Surg Sports Traumatol Arthrosc. 2016;24(6):1931–42.

    Article  Google Scholar 

  3. Schmitt H, Hansmann HJ, Brocai DR, Loew M. Long term changes of the throwing arm of former elite javelin throwers. Int J Sports Med. 2001;22(4):275–9.

    Article  CAS  Google Scholar 

  4. Roach NT, Venkadesan M, Rainbow MJ, Lieberman DE. Elastic energy storage in the shoulder and the evolution of high-speed throwing in Homo. Nature. 2013;498(7455):483–6.

    Article  CAS  Google Scholar 

  5. Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology. Part II: evaluation and treatment of SLAP lesions in throwers. Arthroscopy. 2003;19(5):531–9.

    Article  Google Scholar 

  6. 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.

    Article  Google Scholar 

  7. Braun S, Kokmeyer D, Millett PJ. Shoulder injuries in the throwing athlete. J Bone Joint Surg Am. 2009;91(4):966–78.

    Article  Google Scholar 

  8. 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.

    Article  CAS  Google Scholar 

  9. Fleisig GS, Barrentine SW, Escamilla RF, Andrews JR. Biomechanics of overhand throwing with implications for injuries. Sports Med. 1996;21(6):421–37.

    Article  CAS  Google Scholar 

  10. Leonard J, Hutchinson MR. Shoulder injuries in skeletally immature throwers: review and current thoughts. Br J Sports Med. 2010;44(5):306–10.

    Article  Google Scholar 

  11. 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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  13. 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 Elbow Surg. 1992;1(5):238–45.

    Article  CAS  Google Scholar 

  14. Beitzel K, Reuter S, Imhoff A, Braun S. Die Sportlerschulter: Der 5-Punkte-Check zum Therapieerfolg. Dtsch Z Sportmed. 2016;67:103–10.

    Article  Google Scholar 

  15. Noonan TJ, Shanley E, Bailey LB, Wyland DJ, Kissenberth MJ, Hawkins RJ, Thigpen CA. Professional pitchers with glenohumeral internal rotation deficit (GIRD) display greater humeral retrotorsion than pitchers without GIRD. Am J Sports Med. 2015;43(6):1448–54.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  17. Waldt S, Burkart A, Lange P, Imhoff AB, Rummeny EJ, Woertler K. Diagnostic performance of MR arthrography in the assessment of superior labral anteroposterior lesions of the shoulder. AJR Am J Roentgenol. 2004;182(5):1271–8.

    Article  Google Scholar 

  18. Tirman PF, Bost FW, Steinbach LS, Mall JC, Peterfy CG, Sampson TG, Sheehan WE, Forbes JR, Genant HK. MR arthrographic depiction of tears of the rotator cuff: benefit of abduction and external rotation of the arm. Radiology. 1994;192(3):851–6.

    Article  CAS  Google Scholar 

  19. Tian CY, Cui GQ, Zheng ZZ, Ren AH. The added value of ABER position for the detection and classification of anteroinferior labroligamentous lesions in MR arthrography of the shoulder. Eur J Radiol. 2013;82(4):651–7.

    Article  Google Scholar 

  20. Snyder SJ, Karzel RP, Del Pizzo W, Ferkel RD, Friedman MJ. SLAP lesions of the shoulder. Arthroscopy. 1990;6(4):274–9.

    Article  CAS  Google Scholar 

  21. Maffet MW, Gartsman GM, Moseley B. Superior labrum-biceps tendon complex lesions of the shoulder. Am J Sports Med. 1995;23(1):93–8.

    Article  CAS  Google Scholar 

  22. Powell SE, Nord KD, Ryu RKN. The diagnosis, classification and treatment of SLAP lesions. Oper Tech Sports Med. 2012;20:46–56.

    Article  Google Scholar 

  23. van der Hoeven H, Kibler WB. Shoulder injuries in tennis players. Br J Sports Med. 2006;40(5):435–40; discussion 440.

    Article  Google Scholar 

  24. 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(1):141–61.e126.

    Article  Google Scholar 

  25. Cools AM, Borms D, Castelein B, Vanderstukken F, Johansson FR. Evidence-based rehabilitation of athletes with glenohumeral instability. Knee Surg Sports Traumatol Arthrosc. 2016;24(2):382–9.

    Article  Google Scholar 

  26. McClure P, Balaicuis J, Heiland D, Broersma ME, Thorndike CK, Wood A. A randomized controlled comparison of stretching procedures for posterior shoulder tightness. J Orthop Sports Phys Ther. 2007;37(3):108–14.

    Article  Google Scholar 

  27. Tyler TF, Nicholas SJ, Lee SJ, Mullaney M, McHugh MP. Correction of posterior shoulder tightness is associated with symptom resolution in patients with internal impingement. Am J Sports Med. 2010;38(1):114–9.

    Article  Google Scholar 

  28. Cools AM, Borms D, Cottens S, Himpe M, Meersdom S, Cagnie B. Rehabilitation exercises for athletes with biceps disorders and SLAP lesions: a continuum of exercises with increasing loads on the biceps. Am J Sports Med. 2014;42(6):1315–22.

    Article  Google Scholar 

  29. Ellenbecker TS, Cools A. Rehabilitation of shoulder impingement syndrome and rotator cuff injuries: an evidence-based review. Br J Sports Med. 2010;44(5):319–27.

    Article  Google Scholar 

  30. Reinold MM, Gill TJ, Wilk KE, Andrews JR. Current concepts in the evaluation and treatment of the shoulder in overhead throwing athletes, part 2: injury prevention and treatment. Sports Health. 2010;2(2):101–15.

    Article  Google Scholar 

  31. Creighton DW, Shrier I, Shultz R, Meeuwisse WH, Matheson GO. Return-to-play in sport: a decision-based model. Clin J Sport Med. 2010;20(5):379–85.

    Article  Google Scholar 

  32. Barber A, Field LD, Ryu R. Biceps tendon and superior labrum injuries: decision-marking. J Bone Joint Surg Am. 2007;89(8):1844–55.

    Article  Google Scholar 

  33. Linke RD, Burkart A, Imhoff AB. [The arthroscopic SLAP refixation]. Orthopade. 2003;32(7):627–31.

    Google Scholar 

  34. Chalmers PN, Trombley R, Cip J, Monson B, Forsythe B, Nicholson GP, Bush-Joseph CA, Cole BJ, Wimmer MA, Romeo AA, et al. Postoperative restoration of upper extremity motion and neuromuscular control during the overhand pitch: evaluation of tenodesis and repair for superior labral anterior-posterior tears. Am J Sports Med. 2014;42(12):2825–36.

    Article  Google Scholar 

  35. Erickson BJ, Jain A, Abrams GD, Nicholson GP, Cole BJ, Romeo AA, Verma NN. SLAP lesions: trends in treatment. Arthroscopy. 2016;32(6):976–81.

    Article  Google Scholar 

  36. Laughlin WA, Fleisig GS, Scillia AJ, Aune KT, Cain EL, Dugas JR. Deficiencies in pitching biomechanics in baseball players with a history of superior labrum anterior-posterior repair. Am J Sports Med. 2014;42(12):2837–41.

    Article  Google Scholar 

  37. Park JY, Chung SW, Jeon SH, Lee JG, Oh KS. Clinical and radiological outcomes of type 2 superior labral anterior posterior repairs in elite overhead athletes. Am J Sports Med. 2013;41(6):1372–9.

    Article  Google Scholar 

  38. Braun S, Imhoff AB. [Modern treatment strategies for the long head of the biceps tendon]. Orthopade. 2018;47(2):113–20.

    Article  CAS  Google Scholar 

  39. Denard PJ, Dai X, Hanypsiak BT, Burkhart SS. Anatomy of the biceps tendon: implications for restoring physiological length-tension relation during biceps tenodesis with interference screw fixation. Arthroscopy. 2012;28(10):1352–8.

    Article  Google Scholar 

  40. Braun S, Minzlaff P, Imhoff AB. [Subpectoral tenodesis of the long head of the biceps tendon for pathologies of the long head of the biceps tendon and the biceps pulley]. Oper Orthop Traumatol. 2012;24(6):479–85.

    Google Scholar 

  41. Willinger L, Beitzel K. Überlastung der Supraspinatussehne beim Überkopfsportler. Arthroskopie. 2017;30(3):173–8.

    Article  Google Scholar 

  42. 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.

    Article  Google Scholar 

  43. Franceschi F, Papalia R, Del Buono A, Vasta S, Costa V, Maffulli N, Denaro V. Articular-sided rotator cuff tears: which is the best repair? A three-year prospective randomised controlled trial. Int Orthop. 2013;37(8):1487–93.

    Article  Google Scholar 

  44. Klouche S, Lefevre N, Herman S, Gerometta A, Bohu Y. Return to sport after rotator cuff tear repair: a systematic review and meta-analysis. Am J Sports Med. 2016;44(7):1877–87.

    Article  Google Scholar 

  45. Reuter S, Imhoff AB, Martetschläger F. Impact of rotator cuff surgery on postoperative sporting activity. J Sports Med Phys Fitness. 2018;58(4):480–8.

    PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany

    Lukas N. Muench, Andreas B. Imhoff & Sebastian Siebenlist

Authors
  1. Lukas N. Muench
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  2. Andreas B. Imhoff
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  3. Sebastian Siebenlist
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Corresponding author

Correspondence to Andreas B. Imhoff .

Editor information

Editors and Affiliations

  1. Orthopedics and Traumatology, State University of Campinas – UNICAMP, Campinas / Sao Paulo, Brazil

    Sérgio Rocha Piedade

  2. Orthopaedic Sports Medicine, University of Munich (TUM), München, Bayern, Germany

    Andreas B. Imhoff

  3. Ascot Hospital, Auckland, New Zealand

    Mark Clatworthy

  4. Department of Orthopedics & Traumatology, Federal University of São Paulo, Vila Clementino - São Paulo, São Paulo, Brazil

    Moises Cohen

  5. Espregueira-Mendes Sports Centre, Clínica do Dragão, Porto, Portugal

    João Espregueira-Mendes

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Muench, L.N., Imhoff, A.B., Siebenlist, S. (2019). Shoulder: The Thrower’s Shoulder. In: Rocha Piedade, S., Imhoff, A., Clatworthy, M., Cohen, M., Espregueira-Mendes, J. (eds) The Sports Medicine Physician. Springer, Cham. https://doi.org/10.1007/978-3-030-10433-7_23

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  • DOI: https://doi.org/10.1007/978-3-030-10433-7_23

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-10432-0

  • Online ISBN: 978-3-030-10433-7

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