AANA24 Wrist & Elbow All-Access Pass-CONCURRENT SCIENTIFIC SESSION 2D: Throwing Shoulder and Elbow

Video Transcription

Video Summary

The Throwing Shoulder and Elbow session featured expert discussions on evaluation, pathology, and treatment strategies for overhead athletes, especially pitchers. Dr. Hamilton emphasized comprehensive assessment, starting with pitching mechanics and lower extremity function, noting adaptive changes in the throwing arm and the importance of correlating physical exam with imaging for accurate diagnosis. Posterior labral pathology, particularly in pitchers with posterior instability, was highlighted as distinct from anterior instability, stressing non-operative rehab first and precise surgical repair techniques that avoid overtightening to preserve throwing ability.<br /><br />A debated topic was treatment of superior labrum anterior-posterior (SLAP) tears. Dr. Ma advocated for debridement to preserve function and avoid over-tensioning, citing frequent asymptomatic MRI findings in throwers and modest return-to-play rates after repairs. Dr. Forsy supported wide biceps tenodesis for cases with significant biceps involvement or instability, referencing improved biomechanics and outcomes compared to SLAP repair. Both stressed identifying pain sources and individualized care.<br /><br />Regarding ulnar collateral ligament (UCL) injuries, one panelist argued for repair and augmentation with internal bracing in appropriate cases for quicker return and preservation of anatomy, while another favored reconstruction, especially in high-level athletes with chronic damage, citing better long-term outcomes and less risk. Precise surgical technique and isometric placement of braces/anchors were underscored.<br /><br />Finally, osteochondral allograft transplantation was presented as a viable option for adolescent athletes with unstable capitellar osteochondritis dissecans lesions, offering promising outcomes with articular restoration. Overall, the session highlighted the complexity of throwing arm injuries, the necessity of tailored treatment based on pathology and athlete demands, and the evolving landscape of surgical options to optimize return to play.

Asset Caption

Introduction by Moderators: Xinning Li, M.D., Moin Khan, M.D., M.Sc., F.R.C.S.

Keywords

Throwing shoulder

Elbow injuries

Overhead athletes

Pitching mechanics

Posterior labral pathology

SLAP tears

Biceps tenodesis

Ulnar collateral ligament injuries

Osteochondral allograft transplantation

Capitellar osteochondritis dissecans