Current Controversies in the Management of the Throwing Athlete (2025 Annual Meeting)-Current Controversies in the Management of the Throwing Athlete

Video Transcription

Video Summary

The panel discussion covered current controversies in managing throwing athletes, focusing on common shoulder and elbow injuries in baseball and softball. Dr. Brian Waterman detailed the challenges of diagnosing and treating SLAP (superior labrum anterior-posterior) tears in overhead athletes, emphasizing the importance of differentiating normal anatomical variants from true pathology. He advocated for knotless SLAP repair techniques to avoid over-constraint and discussed biceps tenodesis as an effective alternative in selected cases, especially in older patients or those with poor prognostic factors.<br /><br />Dr. Mike Freehill addressed ulnar collateral ligament (UCL) injuries, comparing repair with internal brace augmentation versus traditional reconstruction. He highlighted the significance of injury location, vascularity, and patient factors in treatment choice. The internal brace repair offers quicker return to play for suitable patients, while hybrid reconstruction remains standard for high-level throwers due to durability concerns. Advanced imaging and specialized stress views are crucial for accurate assessment.<br /><br />Dr. Liz Matzkin focused on anterior and posterior labral tears in throwers, stressing the importance of comprehensive history, physical exam, and imaging for diagnosis. Nonoperative management can be effective for about 50% of patients, but surgery may be necessary for refractory cases. She warned that return to previous performance level is challenging, often taking 8–12 months or longer, due to the need for restoring kinetic chain function without over-constraining the shoulder.<br /><br />Dr. Mary emphasized the high incidence of shoulder injuries in softball, particularly due to unregulated high pitch counts and continuous play. The windmill pitch generates forces comparable to overhand pitching, challenging the misconception that softball pitching is low risk. Injury prevention through pitch regulation, conditioning, and cross-training is vital but understudied.<br /><br />Overall, the session underscored the complexity of managing throwing athletes, the need for individualized treatment strategies incorporating anatomy, biomechanics, and sport-specific demands, and the importance of education and prevention to optimize outcomes.

Asset Caption

Mary K. Mulcahey, M.D., FAANA | Brian R. Waterman, M.D., FAANA | Michael T. Freehill, M.D. | Elizabeth R. Matzkin, M.D.

Keywords

throwing athletes

shoulder injuries

elbow injuries

SLAP tears

knotless SLAP repair

biceps tenodesis

ulnar collateral ligament (UCL) injuries

internal brace repair

labral tears

softball pitching injuries

injury prevention