AANA Fellowship Education - The Throwing Athlete's Shoulder: Shut Down or Operate?-The Throwing Athlete's Shoulder: Shut Down or Operate?

Video Transcription

Video Summary

This webinar from the Anna Fellowship Education Series focuses on the "throwing athlete's shoulder," discussing both operative and non-operative management through a multidisciplinary lens. The expert panel includes physical therapist Chuck Thigpen, orthopedic surgeon Chris Camp, and shoulder specialist Ben Kibler.<br /><br />Chuck Thigpen emphasizes the importance of understanding the throwing shoulder as a cumulative injury rather than an acute event, highlighting that many athletes demonstrate abnormal MRI findings without symptoms. He stresses assessing physical capacity—mobility, muscle performance, and kinetic chain function—and cautions against overuse of trends like weighted ball programs without foundational movement efficiency and core stability. Managing workload with acute-to-chronic load ratios under 20% injury risk is vital. Simple, consistent arm care programs significantly reduce injury risk.<br /><br />Ben Kibler focuses on the scapula's role in injury prevention and optimal pitching mechanics. He explains scapular motions—external rotation before posterior tilt during cocking—and links core stability with scapular control to mitigate internal impingement. He highlights the importance of pronated external rotation, eccentric muscle control (notably of posterior shoulder and biceps), and tailored exercises that improve dynamic stability. His program shows promising reduced injury and surgery rates in high-level throwers.<br /><br />Chris Camp provides a surgical perspective on superior labrum (SLAP) and biceps injuries, clarifying that the labrum and biceps function as one complex. Physical exam and imaging are challenging because many asymptomatic throwers have labral abnormalities. He discusses the limited success rates of SLAP repairs and biceps tenodesis in pitchers, stressing cautious surgical decisions. Camp advocates returning injured shoulders not to textbook anatomy but to a functional "normal adaptation" state suitable for throwing. He also emphasizes non-operative rehab as a first step, reserving surgery for refractory cases.<br /><br />Overall, the discussion underscores that successful management of the throwing shoulder requires recognizing normal adaptations from pathology, prioritizing rehab to build physical capacity and kinetic chain efficiency, understanding injury mechanisms, and judicious use of surgery with tailored techniques preserving mobility. Prevention via workload management and movement quality is key to keeping athletes healthy and performing at their best.

Asset Caption

John M. Tokish, M.D. | Chuck Thigpen, Ph.D., P.T., A.T.C. | William B. Kibler, M.D. | Christopher L. Camp, M.D.

Keywords

throwing athlete's shoulder

operative management

non-operative management

multidisciplinary approach

cumulative injury

workload management

scapular control

core stability

SLAP injuries

rehabilitation

injury prevention