The Throwing Shoulder: The Common Injuries and their Underlying Mechanisms

Abstract

The mechanics of the throwing shoulder are complex, resulting in a variety of adaptations that can lead to increased performance for the athlete. These adaptations can eventually fail and result in pathology to the stabilizing structures of the shoulder, most notably the rotator cuff and glenoid labrum. The understanding of the relationship between the mechanisms and injuries is evolving, resulting in improved diagnostic, therapeutic, and preventative measures. Our goal is to clarify the relationship between the mechanisms, common types of injury, and their appearance on imaging, specifically MRI, in a comprehensive, easy-to-understand manner that will leave you more confident when evaluating this subset of patients.

Keywords

SLAP tear - GIRD - internal impingement

• References

• 1 Kibler WB. The role of the scapula in athletic shoulder function. Am J Sports Med 1998; 26 (2) 325-337
• 2 Meister K. Injuries to the shoulder in the throwing athlete. Part one: Biomechanics/pathophysiology/classification of injury. Am J Sports Med 2000; 28 (2) 265-275
• 3 Braun S, Kokmeyer D, Millett PJ. Shoulder injuries in the throwing athlete. J Bone Joint Surg Am 2009; 91 (4) 966-978
• 4 Wilk KE, Meister K, Andrews JR. Current concepts in the rehabilitation of the overhead throwing athlete. Am J Sports Med 2002; 30 (1) 136-151
• 5 Snyder SJ, Karzel RP, Del Pizzo W, Ferkel RD, Friedman MJ. SLAP lesions of the shoulder. Arthroscopy 1990; 6 (4) 274-279
• 6 Bigliani LU, Codd TP, Connor PM, Levine WN, Littlefield MA, Hershon SJ. Shoulder motion and laxity in the professional baseball player. Am J Sports Med 1997; 25 (5) 609-613
• 7 Morgan CD, Burkhart SS, Palmeri M, Gillespie M. Type II SLAP lesions: three subtypes and their relationships to superior instability and rotator cuff tears. Arthroscopy 1998; 14 (6) 553-565
• 8 Barber A, Field LD, Ryu R. Biceps tendon and superior labrum injuries: decision-marking. J Bone Joint Surg Am 2007; 89 (8) 1844-1855
• 9 Bedi A, Allen AA. Superior labral lesions anterior to posterior-evaluation and arthroscopic management. Clin Sports Med 2008; 27 (4) 607-630
• 10 Knesek M, Skendzel JG, Dines JS, Altchek DW, Allen AA, Bedi A. Diagnosis and management of superior labral anterior posterior tears in throwing athletes. Am J Sports Med 2013; 41 (2) 444-460
• 11 Meserve BB, Cleland JA, Boucher TR. A meta-analysis examining clinical test utility for assessing superior labral anterior posterior lesions. Am J Sports Med 2009; 37 (11) 2252-2258
• 12 Cook C, Beaty S, Kissenberth MJ, Siffri P, Pill SG, Hawkins RJ. Diagnostic accuracy of five orthopedic clinical tests for diagnosis of superior labrum anterior posterior (SLAP) lesions. J Shoulder Elbow Surg 2012; 21 (1) 13-22
• 13 Cartland JP, Crues III JV, Stauffer A, Nottage W, Ryu RK. MR imaging in the evaluation of SLAP injuries of the shoulder: findings in 10 patients. AJR Am J Roentgenol 1992; 159 (4) 787-792
• 14 Bencardino JT, Beltran J, Rosenberg ZS , et al. Superior labrum anterior-posterior lesions: diagnosis with MR arthrography of the shoulder. Radiology 2000; 214 (1) 267-271
• 15 Magee T, Williams D, Mani N. Shoulder MR arthrography: which patient group benefits most?. AJR Am J Roentgenol 2004; 183 (4) 969-974
• 16 Magee T. 3-T MRI of the shoulder: is MR arthrography necessary?. AJR Am J Roentgenol 2009; 192 (1) 86-92
• 17 Smith DK, Chopp TM, Aufdemorte TB, Witkowski EG, Jones RC. Sublabral recess of the superior glenoid labrum: study of cadavers with conventional nonenhanced MR imaging, MR arthrography, anatomic dissection, and limited histologic examination. Radiology 1996; 201 (1) 251-256
• 18 Tuite MJ, Cirillo RL, De Smet AA, Orwin JF. Superior labrum anterior-posterior (SLAP) tears: evaluation of three MR signs on T2-weighted images. Radiology 2000; 215 (3) 841-845
• 19 Jobe CM. Posterior superior glenoid impingement: expanded spectrum. Arthroscopy 1995; 11 (5) 530-536
• 20 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) 238-245
• 21 Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology Part I: pathoanatomy and biomechanics. Arthroscopy 2003; 19 (4) 404-420
• 22 Hodler J, Kursunoglu-Brahme S, Snyder SJ , et al. Rotator cuff disease: assessment with MR arthrography versus standard MR imaging in 36 patients with arthroscopic confirmation. Radiology 1992; 182 (2) 431-436
• 23 Palmer WE, Brown JH, Rosenthal DI. Rotator cuff: evaluation with fat-suppressed MR arthrography. Radiology 1993; 188 (3) 683-687
• 24 Tirman PF, Bost FW, Steinbach LS , et al. MR arthrographic depiction of tears of the rotator cuff: benefit of abduction and external rotation of the arm. Radiology 1994; 192 (3) 851-856
• 25 Giaroli EL, Major NM, Higgins LD. MRI of internal impingement of the shoulder. AJR Am J Roentgenol 2005; 185 (4) 925-929
• 26 Kaplan LD, McMahon PJ, Towers J, Irrgang JJ, Rodosky MW. Internal impingement: findings on magnetic resonance imaging and arthroscopic evaluation. Arthroscopy 2004; 20 (7) 701-704
• 27 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 (3) 253-258
• 28 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) 531-539
• 29 Kibler WB, Kuhn JE, Wilk K , et al. The disabled throwing shoulder: spectrum of pathology—10-year update. Arthroscopy 2013; 29 (1) 141-161 , e26
• 30 Tuite MJ, Petersen BD, Wise SM, Fine JP, Kaplan LD, Orwin JF. Shoulder MR arthrography of the posterior labrocapsular complex in overhead throwers with pathologic internal impingement and internal rotation deficit. Skeletal Radiol 2007; 36 (6) 495-502
• 31 Tehranzadeh AD, Fronek J, Resnick D. Posterior capsular fibrosis in professional baseball pitchers: case series of MR arthrographic findings in six patients with glenohumeral internal rotational deficit. Clin Imaging 2007; 31 (5) 343-348
• 32 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 (6) 637-640
• 33 Borrero CG, Casagranda BU, Towers JD, Bradley JP. Magnetic resonance appearance of posterosuperior labral peel back during humeral abduction and external rotation. Skeletal Radiol 2010; 39 (1) 19-26
• 34 Yamamoto N, Itoi E, Minagawa H , et al. Why is the humeral retroversion of throwing athletes greater in dominant shoulders than in nondominant shoulders?. J Shoulder Elbow Surg 2006; 15 (5) 571-575
• 35 Osbahr DC, Cannon DL, Speer KP. Retroversion of the humerus in the throwing shoulder of college baseball pitchers. Am J Sports Med 2002; 30 (3) 347-353
• 36 Drakos MC, Barker JU, Osbahr DC , et al. Effective glenoid version in professional baseball players. Am J Orthop 2010; 39 (7) 340-344
• 37 Wyland DJ, Pill SG, Shanley E , et al. Bony adaptation of the proximal humerus and glenoid correlate within the throwing shoulder of professional baseball pitchers. Am J Sports Med 2012; 40 (8) 1858-1862
• 38 Polster JM, Bullen J, Obuchowski NA, Bryan JA, Soloff L, Schickendantz MS. Relationship between humeral torsion and injury in professional baseball pitchers. Am J Sports Med 2013; 41 (9) 2015-2021
• 39 Boileau P, Bicknell RT, Mazzoleni N, Walch G, Urien JP. CT scan method accurately assesses humeral head retroversion. Clin Orthop Relat Res 2008; 466 (3) 661-669
• 40 Kronberg M, Broström LA. Humeral head retroversion in patients with unstable humeroscapular joints. Clin Orthop Relat Res 1990; (260) 207-211
• 41 Bernageau J. Imaging of the shoulder in orthopedic pathology. [in French]. Rev Prat 1990; 40 (11) 983-992
• 42 Lauman V, Kramps HA, Computed tomography on recurrent shoulder dislocation. In: Bateman YE, Welsh RP. , eds. Surgery of the Shoulder. Philadelphia, PA: Decker; 1984: 84
• 43 Hernigou P, Duparc F, Hernigou A. Determining humeral retroversion with computed tomography. J Bone Joint Surg Am 2002; 84-A (10) 1753-1762
• 44 Mihata T, McGarry MH, Kinoshita M, Lee TQ. Excessive glenohumeral horizontal abduction as occurs during the late cocking phase of the throwing motion can be critical for internal impingement. Am J Sports Med 2010; 38 (2) 369-374
• 45 Mihata T, Jun BJ, Bui CN , et al. Effect of scapular orientation on shoulder internal impingement in a cadaveric model of the cocking phase of throwing. J Bone Joint Surg Am 2012; 94 (17) 1576-1583
• 46 Seitz AL, Reinold M, Schneider RA, Gill TJ, Thigpen CA. No effect of scapular position on 3-dimensional scapular motion in the throwing shoulder of healthy professional pitchers. J Sport Rehabil 2012; 21 (2) 186-193
• 47 Miniaci A, Mascia AT, Salonen DC, Becker EJ. Magnetic resonance imaging of the shoulder in asymptomatic professional baseball pitchers. Am J Sports Med 2002; 30 (1) 66-73
• 48 Lesniak BP, Baraga MG, Jose J, Smith MK, Cunningham S, Kaplan LD. Glenohumeral findings on magnetic resonance imaging correlate with innings pitched in asymptomatic pitchers. Am J Sports Med 2013; 41 (9) 2022-2027
• 49 Connor PM, Banks DM, Tyson AB, Coumas JS, D'Alessandro DF. Magnetic resonance imaging of the asymptomatic shoulder of overhead athletes: a 5-year follow-up study. Am J Sports Med 2003; 31 (5) 724-727