Glenoid labrum
Adds depth Break stop/centers humeral
Throwing Motion
Kinetic chain concept Sequence of body segment motions Legs and trunk act as force generation Shoulder is force regulation Arm is force delivery
Throwing Mechanics
Wind-up
upper ext flex, hands on ball, lead foot off ground
Throwing Mechanics
Late Cocking
Foot contact Max abd, ext rot (40 to 170
Throwing Mechanics
Acceleration
Max ER to ball release Humerus IR 100 deg / 0.5 sec Accel of arm coincident with
Throwing Mechanics
Follow-through
Ball release, adduction
internal rotation, deceleration Trapezius, serratus anterior, rhomboids, posterior deltoid, teres minor
Throwing Mechanics
Throwing Mechanics
Hyperangulation
Scapula Dyskinesis
Scapula receives forces from the trunk and transfers them to the arm Must retract and protract around thoracic wall for cocking/accel to decel Proper timing critical Glenoid must be positioned and stabilized for the HH accel and decel
Scapula Dyskinesis
Lack of full retraction with cocking Assoc with tight pec major and minor, weak trapezius, serratus anterior, and rhomboids Excessive protraction causes hyperangulation
Scapular Dyskinesis
Kibler et al AJSM 1998
64 patients with Type II SLAPs Scapular dyskinesis in 60/64 41 winging of infero medial scap and depression of acromiom 19 lateral translation (mean 2.2 cm) and entire medial winging
Internal Impingement
Mechanical abutment of undersurface rotator cuff with posterior-superior labrum occurs when arm in abducted and ext rot position can occur with a perfectly reduced head
Internal Impingement
Abduction and External Rotation
Internal Impingement
Pathophysiology
more likely to occur in overhead athlete with
Internal Impingement
Repetitive Compression Labrum Biceps Glenoid Rotator Cuff
Physiologic
H G RC
Pathologic
Pathologic
Internal Impingement
SLAP Lesions
SLAP Biomechanics
Type II SLAP lesion created
Subtle but significant increase ER of 3 deg Significant increase in GH translation
Anterior Instability
Pathologic anterior translation
Jobe Andrews
Anterior capsular attenuation Anterior labral tear Can be secondary to superior labral tear
SLAP Repair
Anterior Instability
Rehab to restore protective mechanics Repair anterior and/or superior labrum if torn Capsular plication for attenuation?*
* Not too tight
Summary
Shoulder instability in throwers is a continuum Usually involves breakdown of kinetic chain protection Must understand and reestablish kinetic chain function and synchrony Try to identify shoulder at risk early in continuum
Summary
As continuum progresses
Pathology occurs in all elements of restraint system