The overhead throwing athlete is an extremely challenging patient in sports medicine. The repetitive microtraumatic stresses imposed on the athlete’s shoulder joint complex during the throwing motion constantly place the athlete at risk for injury. Treatment of the overhead athlete requires the understanding of several principles based on the unique physical characteristics of the overhead athlete and the demands endured during the act of throwing. These principles are described and incorporated in a multiphase progressive rehabilitation program designed to prevent injuries and rehabilitate the injured athlete, both nonoperatively and postoperatively.
AndrewsJRAngeloRL. Shoulder arthroscopy for the throwing athlete. Tech Orthop. 1988;3:75–79.
2.
AndrewsJRBroussardTSCarsonWG. Arthroscopy of the shoulder in the management of partial tears of the rotator cuff: a preliminary report. Arthroscopy. 1985;1(2):117–122.
3.
AndrewsJRKupfermanSPDillmanCJ. Labral tears in throwing and racquet sports. Clin Sports Med. 1991;10(4):901–911.
4.
AndrewsJRTimmermanLAWilkKE. Baseball. In: PettroneFA, ed. Athletic Injuries of the Shoulder. New York: McGraw-Hill; 1995.
5.
BiglianiLUKurzweilPRSchwartzbachCCWolfeINFlatowEL. Inferior capsular shift procedure for anterior-inferior shoulder instability in athletes. Am J Sports Med. 1994;22(5):578–584.
BorichMRBrightJMLorelloDJCieminskiCJBuismanTLudewigPM. Scapular angular positioning at end range internal rotation in cases of glenohumeral internal rotation deficit. J Orthop Sports Phys Ther. 2006;36(12):926–934.
8.
BorsaPADoverGCWilkKEReinoldMM. Glenohumeral range of motion and stiffness in professional baseball pitchers. Med Sci Sports Exerc. 2006;38(1):21–26.
9.
BorsaPAWilkKEJacobsonJACorrelation of range of motion and glenohumeral translation in professional baseball pitchers. Am J Sports Med. 2005;33(9):1392–1399.
10.
BurkhartSSMorganCD. The peel-back mechanism: its role in producing and extending posterior type II SLAP lesions and its effect on SLAP repair rehabilitation. Arthroscopy. 1998;14(6):637–640.
11.
ChenSKWickiewiczTLOtisJC. Glenohumeral kinematics in a muscle fatigue model. Orthop Trans. 1995;18:1126.
12.
DaviesGJDickoff-HoffmanS. Neuromuscular testing and rehabilitation of the shoulder complex. J Orthop Sports Phys Ther. 1993;18(2):449–458.
13.
DeckerMJHintermeisterRAFaberKJHawkinsRJ. Serratus anterior muscle activity during selected rehabilitation exercises. Am J Sports Med. 1999;27(6):784–791.
14.
DiGiovineNMJobeFWPinkM. An electromyographic analysis of the upper extremity in pitching. J Shoulder Elbow Surg. 1992;1:15–25.
15.
DugasJRAndrewsJR. Throwing injuries in the adult. In: DeLeeJCDrezDMillerMD, eds. DeLee and Drez’s Orthopaedic Sports Medicine. Philadelphia, PA: Elsevier Science; 2003:1236–1249.
16.
EllenbeckerTS. Rehabilitation of shoulder and elbow injuries in tennis players. Clin Sports Med. 1995;14(1):87–110.
17.
FleisigGSAndrewsJRDillmanCJEscamillaRF. Kinetics of baseball pitching with implications about injury mechanisms. Am J Sports Med. 1995;23(2):233–239.
18.
FleisigGSBarrentineSWEscamillaRFAndrewsJR. Biomechanics of overhand throwing with implications for injuries. Sports Med. 1996;21(6):421–437.
19.
GuancheCKnattTSolomonowMLuYBarattaR. The synergistic action of the capsule and the shoulder muscles. Am J Sports Med. 1995;23(3):301–306.
20.
HeiderscheitBCMcLeanKPDaviesGJ. The effects of isokinetic vs. plyometric training on the shoulder internal rotators. J Orthop Sports Phys Ther. 1996;23(2):125–133.
21.
JobeCM. Posterior superior glenoid impingement: expanded spectrum. Arthroscopy. 1995;11(5):530–536.
22.
JobeCM. Superior glenoid impingement: current concepts. Clin Orthop Relat Res. 1996;330:98–107.
23.
JobeFW. Impingement problems in the athlete. Instr Course Lect. 1989;38:205–209.
24.
JobeFWBradleyJP. Rotator cuff injuries in baseball: prevention and rehabilitation. Sports Med. 1988;6(6):378–387.
25.
JobeFWGiangarraCEKvitneRSGlousmanRE. Anterior capsulolabral reconstruction of the shoulder in athletes in overhand sports. Am J Sports Med. 1991;19(5):428–434.
26.
JobeFWKvitneRSGiangarraCE. Shoulder pain in the overhand or throwing athlete: the relationship of anterior instability and rotator cuff impingement. Orthop Rev. 1989;18(9):963–975.
27.
JobeFWPinkM. Classification and treatment of shoulder dysfunction in the overhead athlete. J Orthop Sports Phys Ther. 1993;18(2):427–432.
28.
KnattTGuancheCSolomonowMLuYBarattaRZhouBH. The glenohumeral-biceps reflex in the feline. Clin Orthop Relat Res. 1995;314:247–252.
29.
KvitneRSJobeFW. The diagnosis and treatment of anterior instability in the throwing athlete. Clin Orthop Relat Res. 1993;291:107–123.
30.
KvitneRSJobeFWJobeCM. Shoulder instability in the overhand or throwing athlete. Clin Sports Med. 1995;14(4):917–935.
31.
LevitzCLDugasJAndrewsJR. The use of arthroscopic thermal capsulorrhaphy to treat internal impingement in baseball players. Arthroscopy. 2001;17(6):573–577.
32.
LukasiewiczACMcClurePMichenerLPrattNSennettB. Comparison of 3-dimensional scapular position and orientation between subjects with and without shoulder impingement. J Orthop Sports Phys Ther. 1999;29(10):574–583.
33.
LusardiDAWirthMAWurtzDRockwoodCAJr. Loss of external rotation following anterior capsulorrhaphy of the shoulder. J Bone Joint Surg Am. 1993;75(8):1185–1192.
34.
LymanSFleisigGSAndrewsJROsinskiED. Effect of pitch type, pitch count, and pitching mechanics on risk of elbow and shoulder pain in youth baseball pitchers. Am J Sports Med. 2002;30(4):463–468.
35.
MatveyevLP. Perodisienang das sportlichen training. Berlin: Beles & Wernitz; 1972.
36.
MazoueCGAndrewsJR. Repair of full-thickness rotator cuff tears in professional baseball players. Am J Sports Med. 2006;34(2):182–189.
37.
MeisterK. Injuries to the shoulder in the throwing athlete. Part one: biomechanics/pathophysiology/classification of injury. Am J Sports Med. 2000;28(2):265–275.
38.
MeisterK. Injuries to the shoulder in the throwing athlete. Part two: evaluation/treatment. Am J Sports Med. 2000;28(4):587–601.
39.
MeisterK. Internal impingement in the shoulder of the overhand athlete: pathophysiology, diagnosis, and treatment. Am J Orthop. 2000;29(6):433–438.
40.
MihataTLeeYMcGarryMHAbeMLeeTQ. Excessive humeral external rotation results in increased shoulder laxity. Am J Sports Med. 2004;32(5):1278–1285.
41.
MoseleyJBJrJobeFWPinkMPerryJTiboneJ. EMG analysis of the scapular muscles during a shoulder rehabilitation program. Am J Sports Med. 1992;20(2):128–134.
42.
MurrayTACookTDWernerSLSchlegelTFHawkinsRJ. The effects of extended play on professional baseball pitchers. Am J Sports Med. 2001;29(2):137–142.
43.
MyersJBLaudnerKGPasqualeMRBradleyJPLephartSM. Glenohumeral range of motion deficits and posterior shoulder tightness in throwers with pathologic internal impingement. Am J Sports Med. 2006;34(3):385–391.
44.
NuberGWMcCarthyWJYaoJSSchaferMFSukerJR. Arterial abnormalities of the shoulder in athletes. Am J Sports Med. 1990;18(5):514–519.
45.
PoppenNKWalkerPS. Forces at the glenohumeral joint in abduction. Clin Orthop Relat Res. 1978;135:165–170.
46.
ProkopyMPIngersollCDNordenschildEKatchFIGaesserGAWeltmanA. Closed-kinetic chain upper-body training improves throwing performance of NCAA Division I softball players. J Strength Cond Res. 2008;22(6):1790–1798.
47.
ProtzmanRR. Anterior instability of the shoulder. J Bone Joint Surg Am. 1980;62(6):909–918.
48.
ReinoldMMEscamillaRFWilkKE. Current concepts in the scientific and clinical rationale behind exercises for glenohumeral and scapulothoracic musculature. J Orthop Sports Phys Ther. 2009;39(2):105–117.
49.
ReinoldMMGillTJ. Current concepts in the evaluation and treatment of the shoulder in overhead throwing athletes: Part 1: Physical characteristics and clinical examination. Sports Health. 2010;2:39–50.
50.
ReinoldMMMacrinaLCWilkKEElectromyographic analysis of the supraspinatus and deltoid muscles during 3 common rehabilitation exercises. J Athl Train. 2007;42(4):464–469.
ReinoldMMWilkKEFleisigGSElectromyographic analysis of the rotator cuff and deltoid musculature during common shoulder external rotation exercises. J Orthop Sports Phys Ther. 2004;34(7):385–394.
53.
ReinoldMMWilkKEHooksTRDugasJRAndrewsJR. Thermal-assisted capsular shrinkage of the glenohumeral joint in overhead athletes: a 15- to 47-month follow-up. J Orthop Sports Phys Ther. 2003;33(8):455–467.
54.
ReinoldMMWilkKEMacrinaLCChanges in shoulder and elbow passive range of motion after pitching in professional baseball players. Am J Sports Med. 2008;36(3):523–527.
55.
ReinoldMMWilkKEReedJCrenshawKAndrewsJR. Interval sport programs: guidelines for baseball, tennis, and golf. J Orthop Sports Phys Ther. 2002;32(6):293–298.
56.
RohrerMJCardulloPAPappasAMPhillipsDAWheelerHB. Axillary artery compression and thrombosis in throwing athletes. J Vasc Surg. 1990;11(6):761–768.
57.
RuotoloCPriceEPanchalA. Loss of total arc of motion in collegiate baseball players. J Shoulder Elbow Surg. 2006;15(1):67–71.
58.
SalterRBBellRSKeeleyFW. The protective effect of continuous passive motion in living articular cartilage in acute septic arthritis: an experimental investigation in the rabbit. Clin Orthop Relat Res. 1981;159:223–247.
59.
SalterRBHamiltonHWWedgeJHClinical application of basic research on continuous passive motion for disorders and injuries of synovial joints: a preliminary report of a feasibility study. J Orthop Res. 1984;1(3):325–342.
60.
SalterRBSimmondsDFMalcolmBWRumbleEJMacMichaelDClementsND. The biological effect of continuous passive motion on the healing of full-thickness defects in articular cartilage: an experimental investigation in the rabbit. J Bone Joint Surg Am. 1980;62(8):1232–1251.
61.
ScarpinatoDFBramhallJPAndrewsJR. Arthroscopic management of the throwing athlete’s shoulder: indications, techniques, and results. Clin Sports Med. 1991;10(4):913–927.
62.
Schulte-EdelmannJADaviesGJKernozekTWGerberdingED. The effects of plyometric training of the posterior shoulder and elbow. J Strength Cond Res. 2005;19(1):129–134.
63.
Solem-BertoftEThuomasKAWesterbergCE. The influence of scapular retraction and protraction on the width of the subacromial space: an MRI study. Clin Orthop Relat Res. 1993;296:99–103.
64.
SottaRP. Vascular problems in the proximal upper extremity. Clin Sports Med. 1990;9(2):379–388.
65.
ThigpenCAReinoldMMPaduaDASchneiderRSDistefanoLJGillTJ. 3-D scapular position and muscle strength are related in professional baseball pitchers. J Athl Train. 2008;43(2):S49.
66.
TownsendHJobeFWPinkMPerryJ. Electromyographic analysis of the glenohumeral muscles during a baseball rehabilitation program. Am J Sports Med. 1991;19(3):264–272.
67.
VoightMLHardinJABlackburnTATippettSCannerGC. The effects of muscle fatigue on and the relationship of arm dominance to shoulder proprioception. J Orthop Sports Phys Ther. 1996;23(6):348–352.
68.
WalkerPSPoppenNK. Biomechanics of the shoulder joint during abduction in the plane of the scapula [proceedings]. Bull Hosp Joint Dis. 1977;38(2):107–111.
69.
WilkKEMeisterKAndrewsJR. Current concepts in the rehabilitation of the overhead throwing athlete. Am J Sports Med. 2002;30(1):136–151.
70.
WilkKEReinoldMMAndrewsJR. Rehabilitation of the thrower’s elbow. Clin Sports Med. 2004;23(4):765–801.
71.
WilkKEReinoldMMDugasJRAndrewsJR. Rehabilitation following thermal-assisted capsular shrinkage of the glenohumeral joint: current concepts. J Orthop Sports Phys Ther. 2002;32(6):268–292.
72.
WilkKEReinoldMMDugasJRArrigoCAMoserMWAndrewsJR. Current concepts in the recognition and treatment of superior labral (SLAP) lesions. J Orthop Sports Phys Ther. 2005;35(5):273–291.
73.
WilkKEVoightMLKeirnsMAGambettaVAndrewsJRDillmanCJ. Stretch-shortening drills for the upper extremities: theory and clinical application. J Orthop Sports Phys Ther. 1993;17(5):225–239.
74.
WorrellTWCoreyBJYorkSLSantiestabanJ. An analysis of supraspinatus EMG activity and shoulder isometric force development. Med Sci Sports Exerc. 1992;24(7):744–748.
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