pathology: thrower’s shoulder

yogabook / pathologie / thrower’s shoulder

thrower’s shoulder / athlete’s shoulder

Definition of

The throwing motion consists of three phases (lunge, accelerate, decelerate), the last of which is the most critical because the exorotators must eccentrically decelerate the throwing motion, which also stresses and thickens the posterior capsule of the capsule, worsening endorotation(GIRD -glenohumeral internal rotational deficit). This should serve as a warning sign for the development of impingement. Various types of damage to the shoulder can occur:

  1. Fraying of the rotator cuff: partial tears, visible arthroscopically, e.g. as PASTA damage
  2. SLAP lesions
  3. posterosuperior impingement (the classic impingement)
  4. anterosuperior impingement (rare: the subscapularis tendonbecomes trapped between the humeral head and the coracoid or anterior labrum )

The case of a rotator tear with a partial tear of the lower surface of the infraspinatus tendonis called APIT (anteroposterior instability in the throwing athlete). The risk of injury in overhead sports without differentiation between acute traumatic and chronic degenerative: swimming (40-90%), volleyball and tennis (20-60%), baseball (60-70%). Forces of up to 1000 N occur during throwing. Changes in the shoulder can be detected after just 40-60 throws

Cause

  1. Repeated powerful overhead throwing and striking movement

Predisposing

  1. Enodorotation deficit (see GIRD test)

Diagnosis

  1. Rather loose connection between radiology and clinic
  2. Arthroscopy with measures depending on the damage
  3. Tests and signs: GIRD test (positive from 20% difference in side comparison)

Symptoms

  1. Movement pain, progressive, load-dependent, intra-articular
  2. Progressive terminal restriction of flexibility
  3. Slightly reduced retraction of the scapula
  4. Power reduction
  5. Scapular dyskinesia
  6. Subjective and objective joint instability

Complications

  1. Rotator tears
  2. Labrum damage
  3. SLAP lesion

Therapy

  1. if GIRD (glenohumeral internal rotational deficit) is recognized early: PT, adaptation of the throwing technique and other sports physiotherapy measures such as stretching of the pectoralis major, shoulder crossbody stretch (maximally transversely adduct the 90° frontally abducted arm), sleeper stretch (in lateral position with 90° frontal abduction of one arm, maximally endorotate this arm with the other hand)
  2. otherwise arthroscopic intervention is usually necessary. Good prognosis