AOSSM/AANA Specialty Day 2020-Handout 2 - Evaluation and Approach to the Thrower’s Shoulder

Handout 2 - Evaluation and Approach to the Thrower’s Shoulder

Pdf Summary

This presentation by Dr. Michael T. Freehill from Stanford University addresses the evaluation and management of the thrower’s shoulder, particularly in overhead-throwing athletes such as baseball pitchers. Throwing involves a complex interplay of strength, flexibility, balance, and neuromuscular control, with certain physiological adaptations expected. Physicians must be aware of these when assessing athletes.<br /><br />A detailed patient history is crucial, covering pain location, symptom duration, trauma history, neurologic symptoms, prior injuries, and treatments. For throwers, additional sport-specific history is essential, including player position, throwing role (starter vs. reliever), throwing volume (innings, games), rest periods, velocity changes, control issues, pitch types, and pain triggers.<br /><br />The physical exam must be comprehensive and include assessment beyond the throwing arm to the entire kinetic chain—hips, knees, ankles, core, and scapula. Identifying asymmetries, strength imbalances, and range of motion (ROM) differences is key. Hip evaluation includes leg length and ROM comparisons; core strength and control are assessed via functional tests such as step-down and Trendelenburg.<br /><br />Scapular evaluation focuses on recognizing SICK scapula syndrome (Scapular malposition, Inferior medial border prominence, Coracoid pain, dysKinesis). Addressing scapular issues with specific strengthening and stretching can enable return to pain-free throwing.<br /><br />Throwers often present with characteristic ROM adaptations—particularly increased external rotation and decreased internal rotation at 90° abduction, maintaining total arc of motion. Glenohumeral Internal Rotation Deficit (GIRD) greater than 20 degrees warrants corrective measures.<br /><br />Muscle examination includes inspection for atrophy (infraspinatus, deltoid), strength testing (including use of dynamometer), and labral evaluation with provocative tests (O’Brien’s, Mayo Shear, Jerk tests). Neurovascular testing is essential to exclude thoracic outlet syndrome.<br /><br />In summary, assessment extends beyond the shoulder to identify imbalances and weaknesses throughout the athlete’s kinetic chain, enabling tailored interventions to prevent injury and improve performance. Ongoing maintenance and athlete-specific rehabilitation are critical for successful outcomes.

Keywords

thrower's shoulder

overhead-throwing athletes

shoulder evaluation

kinetic chain assessment

SICK scapula syndrome

Glenohumeral Internal Rotation Deficit (GIRD)

shoulder range of motion adaptations

labral injury tests

neurovascular testing

athlete-specific rehabilitation