2023 Annual Meeting Wrist & Elbow Access Pass-Panel Discussion

Video Transcription

Video Summary

The discussion centers on managing throwing athletes' upper extremity injuries, focusing on shoulder and elbow pathologies. The panel debated the relevance of Glenohumeral Internal Rotation Deficit (GERD), concluding it's not "dead" but has evolved; internal rotation loss must be contextualized with humeral torsion and total rotational range. Overstretching posterior capsules indiscriminately is cautioned against. For Tommy John surgery, consensus favors autograft use (usually gracilis), minimal nerve decompression unless symptomatic, and skepticism toward allografts. AC joint grade 3 separations in throwers are generally managed non-operatively unless horizontal instability persists.<br /><br />Posterior shoulder instability is complex; MRI often underdetects lesions, making thorough clinical exams vital. Repairs focus on reattaching labrum without over-tightening capsules to preserve motion; outcomes vary, with ~78% returning to throwing. Kim lesions and posterior labral tears require individualized approach—often conservative or limited repair—to avoid compromising throwing mechanics. Rotator cuff tears in throwers have poor prognosis; debridement rather than extensive repairs is preferred.<br /><br />Elbow discussions emphasized careful imaging (MRA with appropriate sequences), skepticism toward PRP for acute or mid-substance UCL tears, and preference for reconstruction over repair in high-demand throwers. Postoperative protocols vary, but early motion and brace use are typical. Return to sport timelines align with baseball pitchers—roughly 8-12 months, depending on discipline and severity. Overall, the panel highlighted nuanced assessment and tailored treatment, emphasizing rehabilitation and caution against overtreatment to optimize outcomes in throwing athletes.

Asset Caption

Moderators: John D. Kelly IV, M.D., FAANA, Kelly G. Kilcoyne, M.D.
Panelists: Michael T. Freehill, M.D., Steven B. Cohen, M.D., John E. Conway, M.D., Justin W. Griffin, M.D., Charles A. Thigpen, Ph.D., P.T., A.T.C., E. Lyle Cain, M.D.

Keywords

throwing athletes

upper extremity injuries

Glenohumeral Internal Rotation Deficit

Tommy John surgery

posterior shoulder instability

rotator cuff tears

ulnar collateral ligament reconstruction