Common Shoulder Problems in Overhead Sports: An Interactive, Round Table, Case-Based, Problem-Solving Session (2021 Annual Meeting)-Common Shoulder Problems in Overhead Sports: An Interactive, Round Table, Case-Based, Problem-Solving Session

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Video Summary

The transcript presents two detailed case discussions focused on challenging shoulder conditions in overhead athletes. The first case involves a 17-year-old female elite volleyball player with chronic shoulder pain characterized by laxity without instability, early fatigue, and scapular dyskinesia despite extensive rehabilitation. Diagnostic findings include a positive sulcus sign and capsular laxity, but no labral tear. Treatment options debated include continued conservative care, diagnostic and therapeutic injections, and arthroscopic capsular shift surgery with rotator interval closure. Experts emphasize the importance of scapular function in rehabilitation, cautioning that addressing the scapula and core musculature is essential for successful outcomes. They also warn against unnecessary procedures such as subacromial decompression in young athletes and discuss differing strategies for capsular plication using non-absorbable sutures and knot techniques. Return-to-sport rates post-surgery are estimated around 70-75%.<br /><br />The second case features an 18-year-old male pitcher with anterior and posterior shoulder pain and a posterior superior labral tear visible on MRI and arthroscopy. Symptoms include painful throwing, fatigue, and mild scapular dyskinesia. Conservative management included physical therapy and a throwing program, with partial symptom relief from selective biceps injections. Arthroscopic findings show undersurface rotator cuff fraying and posterior superior labral detachment. Treatment considerations focus on minimizing surgical intervention due to varied tissue pathology and the high failure rate of aggressive surgery in throwers. Emphasis is placed on precise biomechanical assessment, specialized rehabilitation with experienced therapists, and cautious postoperative follow-up to avoid loss of external rotation, crucial for pitchers. The discussions highlight the complexity of diagnosing and managing overhead-throwing shoulder injuries, advocating individualized treatment plans prioritizing non-operative care and selective surgery when necessary.

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Richard K.N. Ryu, M.D. | Nikhil N. Verma, M.D.

Keywords

overhead athletes

shoulder pain

scapular dyskinesia

capsular laxity

arthroscopic capsular shift

rotator interval closure

labral tear

conservative management

throwing program

biomechanical assessment