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Why Is the Athlete in Your Office? Making the Right Diagnosis in the Disabled Throwing Shoulder

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Mechanics, Pathomechanics and Injury in the Overhead Athlete

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Abstract

The athlete with the disabled throwing shoulder presents a challenge to evaluate and treat. The clinical symptoms may vary widely; there are “normal” adaptations in flexibility and strength in overhead athletes; otherwise “pathologic” findings may be part of the adaptive process, and imaging may be imprecise. Difficulty in establishing the diagnosis may result in variation in treatment and inconsistency in outcomes. The clinician must develop a comprehensive plan for making the diagnosis of all of the factors that result in the dysfunction that brings the athlete to the office. The dysfunction has components of pathoanatomy, pathophysiology, and pathomechanics and can be affected by patient-specific factors.

History considerations include the patient’s description of the dysfunction and limitations, the clinical course and degree of disability, and the past medical history. Physical exam considerations include leg/core stability and strength, evaluation of scapular position and motion, and the shoulder exam, with emphasis on glenohumeral (GH) motion and specific tests for anatomic injury. Imaging can be used as a confirmatory tool. Patient-specific factors should evaluate psychological and social aspects that affect the dysfunction. All of this information can provide “value on the front end,” a comprehensive diagnosis that can guide implementation of the content and timing of the treatment.

“Value on the back end” is the outcome or how well did the treatment allow the athlete to return to activity. Self-reported tools may help, but throwing-specific tools provide effective measures of disability and outcomes.

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Authors and Affiliations

  1. Mayo Clinic, Department of Orthopedic Surgery, Phoenix, AZ, USA

    John M. Tokish

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

    W. Ben Kibler

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Editors and Affiliations

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

    W. Ben Kibler

  2. Eastern Kentucky University, Richmond, KY, USA

    Aaron D. Sciascia

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Tokish, J.M., Kibler, W.B. (2019). Why Is the Athlete in Your Office? Making the Right Diagnosis in the Disabled Throwing Shoulder. In: Kibler, W., Sciascia, A. (eds) Mechanics, Pathomechanics and Injury in the Overhead Athlete. Springer, Cham. https://doi.org/10.1007/978-3-030-12775-6_4

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