AOSSM/AANA Specialty Day 2020-Handout 1 - Evaluation and Approach to the Thrower’s Shoulder

Handout 1 - Evaluation and Approach to the Thrower’s Shoulder

Pdf Summary

Dr. Michael T. Freehill discusses the evaluation and approach to the "thrower’s shoulder," focusing on athletes involved in overhead throwing sports like baseball. Throwing is a highly complex motion involving extreme angular velocities up to 7,250 degrees per second, requiring a delicate balance of strength, flexibility, coordination, and neuromuscular control. <br /><br />A thorough history is vital, including pain location, symptom duration, trauma, neurologic symptoms, and prior treatments. Baseball-specific factors such as player position, type (starter or reliever), throwing phase during symptoms, workload, rest, loss of velocity or control, and which pitches provoke pain are assessed.<br /><br />The physical examination must be comprehensive, evaluating the entire kinetic chain—hips, knees, ankles—in addition to the shoulder. Specific hip assessments include leg length, range of motion differences, and provocative tests (e.g., FABER). Core strength and balance (e.g., Trendelenburg test) and scapular positioning are critical. Scapular dyskinesis, identified by malposition or movement abnormalities like SICK scapula, responds well to nonoperative treatments such as parascapular strengthening and pectoralis minor stretching.<br /><br />Physiologic adaptations in throwers typically include increased external rotation at 90° abduction, decreased internal rotation, and maintenance of overall range of motion. Glenohumeral Internal Rotation Deficit (GIRD) has been linked to higher injury risk, though no strict threshold is universally accepted. <br /><br />Rotator cuff and superior labrum examinations use specialized tests (e.g., O’Brien’s, Mayo Shear), along with neurovascular screening for thoracic outlet syndrome. <br /><br />In conclusion, assessment should extend beyond the injured shoulder to identify imbalances, enabling tailored workout programs to prevent injuries, maintain shoulder health, and enhance performance in overhead throwing athletes.

Keywords

thrower's shoulder

overhead throwing sports

baseball injuries

shoulder evaluation

kinetic chain assessment

scapular dyskinesis

Glenohumeral Internal Rotation Deficit

rotator cuff examination

thoracic outlet syndrome

throwing biomechanics