- See: throwing
injuries: and
elbow throwing injuries
- Phases of Throwing:
- wind up
- early cocking:
deltoid and
rotator
cuff are active;
- late cocking phase:
- muscle activity:
- shoulder is placed in hyper-external rotation;
- pectoralis
major and the
subscapularis (shoulder adductors) and the
latissimus
and teres major
(internal rotators) are placed under eccentric stress;
- supraspinatus is also active during this stage (by EMG analysis);
- biceps
contracts (for elbow flexion)
-
recurrent anterior instability:
- posterior glenohumeral pain and anterior subluxation occurs during late
cocking and early acceleration phases;
- w/ complaints of a painful clicking (dead arm syndrome) during this phase,
consider
recurrent anterior instability;
- references:
- Shoulder instability in the overhand orthrowing athlete. Kvitne RS, Jobe FW,
Jobe CM. Clin Sports Med 1995;14:917-935.
-
posterior impingement:
-
SLAP lesion - type II
-
quadrilatateral
space syndrome
- also note that the rare
quadrilatateral
space syndrome occurs when the arm is abducted and exteranally rotated
and is characterized by positional compression of the
posterior humeral circumflex artery and the
axillary nerve;
- references:
- Rotator cuf and postero-superior glenoid labrum injury associated with
increased glenohumeral motion: a new site of impingment syndrome:
PA Davidson et al. J. Shoulder and Elbow Surg. Vol
4. 1995 p 384-390.
- Posterosuperior glenoid impingement of the shoulder: findings at MR imaging
and MR arthrography with arthroscopic correlation.
PF Terman et al. Radiology. Vol 193. p 431. 1994.
- A Cadaveric Model
of the Throwing Shoulder: A Possible Etiology of Superior Labrum
Anterior-to-Posterior Lesions.
- Evidence for Posterior Internal Impingement of the Rotator Cuff. Paley
Arthroscopy: Vol 16, No 1 (Jan-Feb), 2000: pp 35-40
- Impingement of the deep surface of the supraspinatus tendon on the
posterosuperior glenoid rim: An arthroscopic study.
Walch G, Boileau P, Noel E, Donell ST. J Shoulder Elbow Surg 1992;1:238-245.
-
Anterior instability increases superior labral strain in the late cocking phase
of throwing.
- acceleration phase:
-
pectoralis,
latissimus,
serratus,
and
subscapularis are active;
- rotator cuff and biceps are inactive;
- follow thru:
- most activity deliberate;
- stresses posterior capsule;
- throwing athletes with symptomatic internal rotation deficits should have an
intensive posterior capsular stretching program;
- patients that fail to respond to streching may consider an arthroscopic
posterior capsular release;
- references: Glenohumeral ROM deficits and posterior shoulder tightness in
throwers w/ pathologic internal impingement. Am J Sports Med 2006;34:385-391.
- pain with follow thru (phase 3) may indicate
posterior instability;
-
rotator
cuff is eccentrically loaded mainly during this phase;;
-
biceps
contracts to prevent elbow hyperextension;
- Specific Conditions:
-
SLAP lesions:
-
Thoracic
Outlet
- Arterial
and Venous Injuries in Athletes. Findings and Their Effect on Diagnosis
and Treatment
- DVT
-
Paget-Schroetter syndrome: spontaneous thrombosis of the axillary/subclavian
vein
- most often affects young, active adults who
are engaged in sports activities or whose professions require repetitive arm
movements
-
Comprehensive surgical management of competitive athlete with effort thrombosis
of the subclavian vein (Paget-Schroetter syndrome).
- Little League Shoulder:
(epiphysiolysis of the proximal humerus);
- osteochondrosis
of the proximal humeral epiphysis due to overuse from throwing;
- radiographs show
physeal widening, fragmentation, and/or sclerosis of the lateral aspect of the
proximal humeral physis;
- lateral
metaphyseal fragmentation and/or sclerosis
- references:
- Little
Leaguer’s Shoulder. A Report of 23 Cases.
- Muscle
Strength and Range of Motion in Adolescent Pitchers With Throwing-Related Pain.
Implications for Injury Prevention