Shoulder Injuries in Overhead Athletes

2019 ◽  
pp. 23-51
Author(s):  
Teruhisa Mihata
Keyword(s):  
Shoulder Injuries ◽  
Overhead Athletes

scholarly journals Direct Comparison of Modified Jobe and Docking Ulnar Collateral Ligament Reconstruction at Midterm Follow-up

2018 ◽  
Vol 47 (1) ◽  
pp. 144-150 ◽  
Author(s):  
Justin W. Arner ◽  
Edward S. Chang ◽  
Stephen Bayer ◽  
James P. Bradley
Keyword(s):  
Reconstructive Surgical Procedures ◽  
Ulnar Collateral Ligament ◽  
Return To Play ◽  
Shoulder Injuries ◽  
Collateral Ligament ◽  
Level Of Evidence ◽  
Overhead Athletes ◽  
Additional Surgery ◽  
Significant Difference

Background: The modified Jobe and docking techniques are the 2 most commonly employed techniques for ulnar collateral ligament (UCL) reconstruction among overhead athletes. However, no study has directly compared these techniques performed by a single surgeon. Current comparisons of these techniques have relied solely on systematic reviews and biomechanical studies. Hypothesis: There will be no difference in outcomes or return to play between the modified Jobe and docking techniques in elbow UCL reconstruction surgery. Study Design: Cohort study; Level of evidence, 3. Methods: Twenty-five modified Jobe and 26 docking UCL-reconstructive surgical procedures were performed by a single surgeon, each with a minimum 2-year follow-up. Kerlan-Jobe Orthopaedic Clinic (KJOC) score, Conway Scale, years played, sex, handedness, sport, position, palmaris versus gracilis graft type, concomitant or future arm/shoulder injuries, and need for additional surgery were compared between the groups. Patients who underwent future shoulder or elbow surgery, no matter the cause, were included. Results: No difference was seen between the modified Jobe and docking reconstruction cases in regard to KJOC scores (mean ± SD: 78.4 ± 19.5 vs 72.0 ± 26.0, P = .44), Conway Scale (return to play, any level: 84% vs 82%, P = .61), years played (14.7 ± 6.2 vs 15.2 ± 5.8, P = .52), sex ( P = .67), handedness ( P ≥ .999), sport ( P = .44), position ( P = .60), level of competition ( P = .59), and future surgery (12% vs 4%, P = .35). Palmaris graft type had significantly higher KJOC scores than hamstring grafts (82.3 ± 20.0 vs 57.9 ± 21.2, P = .001). The mean follow-up was 6.1 years in the modified Jobe group and 7.3 years in the docking group (mean = 6.7, P = .47). Conclusion: The modified Jobe and docking techniques are both suitable surgical options for elbow UCL reconstruction. There was no statistically significant difference between the techniques in regard to return to play, KJOC score, or need for subsequent surgery at 6.7-year follow-up. This is the first direct clinical comparison of these 2 techniques by a single surgeon at midterm follow-up.

scholarly journals Risk Factors of Overuse Shoulder Injuries in Overhead Athletes: A Systematic Review

2020 ◽  
Vol 12 (5) ◽  
pp. 478-487 ◽  
Author(s):  
Camille Tooth ◽  
Amandine Gofflot ◽  
Cédric Schwartz ◽  
Jean-Louis Croisier ◽  
Charlotte Beaudart ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Rotator Cuff ◽  
Range Of Motion ◽  
Training Load ◽  
Shoulder Injuries ◽  
Shoulder Injury ◽  
Overhead Athletes ◽  
Modifiable Factors ◽  
And Training

Context: Shoulder injuries are highly prevalent in sports involving the upper extremity. Some risk factors have been identified in the literature, but consensus is still lacking. Objectives: To identify risk factors of overuse shoulder injury in overhead athletes, as described in the literature. Data Sources: A systematic review of the literature from the years 1970 to 2018 was performed using 2 electronic databases: PubMed and Scopus. Study Selection: Prospective studies, written in English, that described at least 1 risk factor associated with overuse shoulder injuries in overhead sports (volleyball, handball, basketball, swimming, water polo, badminton, baseball, and tennis) were considered for analysis. Study Design: Systematic review. Level of Evidence: Level 3. Data Extraction: Data were extracted from 25 studies. Study methodology quality was evaluated using the Modified Coleman Methodology Score. Results: Intrinsic factors, previous injury, range of motion (lack or excess), and rotator cuff weakness (isometric and isokinetic) highly increase the risk of future injuries. Additionally, years of athletic practice, body mass index, sex, age, and level of play seem to have modest influence. As for the effect of scapular dysfunction on shoulder injuries, it is still controversial, though these are typically linked. Extrinsic factors, field position, condition of practice (match/training), time of season, and training load also have influence on the occurrence of shoulder injuries. Conclusion: Range of motion, rotator cuff muscle weakness, and training load are important modifiable factors associated with shoulder injuries. Scapular dysfunction may also have influence. The preventive approach for shoulder injury should focus on these factors.

scholarly journals Shoulder External Rotation Fatigue and Scapular Muscle Activation and Kinematics in Overhead Athletes

2011 ◽  
Vol 46 (4) ◽  
pp. 349-357 ◽  
Author(s):  
Mithun Joshi ◽  
Charles A. Thigpen ◽  
Kevin Bunn ◽  
Spero G. Karas ◽  
Darin A. Padua
Keyword(s):  
Muscle Fatigue ◽  
Muscle Activation ◽  
External Rotation ◽  
Shoulder Injuries ◽  
Serratus Anterior ◽  
Overhead Athletes ◽  
Scapular Kinematics ◽  
Fatigue Protocol ◽  
Upper Trapezius ◽  
Lower Trapezius

Context: Glenohumeral external rotation (GH ER) muscle fatigue might contribute to shoulder injuries in overhead athletes. Few researchers have examined the effect of such fatigue on scapular kinematics and muscle activation during a functional movement pattern. Objective: To examine the effects of GH ER muscle fatigue on upper trapezius, lower trapezius, serratus anterior, and infraspinatus muscle activation and to examine scapular kinematics during a diagonal movement task in overhead athletes. Setting: Human performance research laboratory. Design: Descriptive laboratory study. Patients or Other Participants: Our study included 25 overhead athletes (15 men, 10 women; age = 20 ± 2 years, height = 180 ± 11 cm, mass = 80 ± 11 kg) without a history of shoulder pain on the dominant side. Intervention(s): We tested the healthy, dominant shoulder through a diagonal movement task before and after a fatiguing exercise involving low-resistance, high-repetition, prone GH ER from 0° to 75° with the shoulder in 90° of abduction. Main Outcome Measure(s): Surface electromyography was used to measure muscle activity for the upper trapezius, lower trapezius, serratus anterior, and infraspinatus. An electromyographic motion analysis system was used to assess 3-dimensional scapular kinematics. Repeated-measures analyses of variance (phase × condition) were used to test for differences. Results: We found a decrease in ascending-phase and descending-phase lower trapezius activity (F1,25 = 5.098, P = .03) and an increase in descending-phase infraspinatus activity (F1,25 = 5.534, P = .03) after the fatigue protocol. We also found an increase in scapular upward rotation (F1,24 = 3.7, P = .04) postfatigue. Conclusions: The GH ER muscle fatigue protocol used in this study caused decreased lower trapezius and increased infraspinatus activation concurrent with increased scapular upward rotation range of motion during the functional task. This highlights the interdependence of scapular and glenohumeral force couples. Fatigue-induced alterations in the lower trapezius might predispose the infraspinatus to injury through chronically increased activation.

scholarly journals Are muscle weakness and stiffness risk factors of the development of rotator cuff tendinopathy in overhead athletes: a systematic review

2021 ◽  
Vol 12 ◽  
pp. 204062232110261
Author(s):  
Cheuk-Kin Kwan ◽  
Man-Chi Ko ◽  
Sai-Chuen Fu ◽  
Hio-Teng Leong ◽  
Samuel Ka-Kin Ling ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Risk Factor ◽  
Rotator Cuff ◽  
Muscle Weakness ◽  
Prospective Studies ◽  
Shoulder Injuries ◽  
Limited Evidence ◽  
Overhead Athletes ◽  
Rotator Cuff Tendinopathy

Background: Underlying muscle weakness and stiffness may increase the risk of developing rotator cuff tendinopathy. This systematic review aims to assess existing prospective studies to summarize whether muscle weakness and stiffness are risk factors for the development of rotator cuff tendinopathy in overhead athletes. Methods: A systematic search was performed using PRISMA guidelines. Prospective studies measuring muscle strength or stiffness and the incidence of rotator cuff tendinopathy were included. Quality assessment was performed with the Newcastle-Ottawa quality assessment scale. Results: The search yielded six studies, with a total of 523 trained overhead athletes followed up for one season. External rotation (ER) and internal rotation (IR) strength were described as protective factors against the development of rotator cuff tendinopathy. Athletes who did not sustain shoulder injuries had statistically stronger eccentric IR ( p < 0.01) and ER ( p < 0.05) strength in the pre-season assessment. Muscle stiffness indicated by limited range of motion of <106° for shoulder ER was described as a risk factor with an odds ratio of 1.12 ( p < 0.001). Imbalance between ER and IR strength was reported as risk factors for shoulder injuries in two studies, with a relative risk of 2.57 ( p < 0.05) reported in one study. Supraspinatus weakness was also reported as a risk factor for shoulder injuries in one study. Conclusion: Limited evidence support ER, IR weakness, limited ER range of motion, and very limited evidence support imbalance in ER/IR strength, and supraspinatus weakness as risk factors for rotator cuff tendinopathy in overhead athletes. No existing studies investigated the general population on this topic. Future cohort studies may improve on existing evidence with investigations on the general public, a longer follow-up time, clearly documented injury history, and a stringent diagnosis to rotator cuff tendinopathy.

scholarly journals Prevention of shoulder injuries in overhead athletes: a science-based approach

2015 ◽  
Vol 19 (5) ◽  
pp. 331-339 ◽  
Author(s):  
Ann M. Cools ◽  
Fredrik R. Johansson ◽  
Dorien Borms ◽  
Annelies Maenhout
Keyword(s):  
Shoulder Injuries ◽  
Overhead Athletes

STRENGTHENING AND STABILIZATION EXERCISES IN PREVENTION OF SHOULDER INJURIES

sportlogia ◽  
2020 ◽  
Vol 16 (1) ◽  
pp. 149-160
Author(s):  
Bernarda Letnar ◽  
Keyword(s):  
Training Program ◽  
Internal Rotation ◽  
Shoulder Joint ◽  
External Rotation ◽  
Shoulder Injuries ◽  
Serratus Anterior ◽  
Warm Up ◽  
Overhead Athletes ◽  
Daily Training ◽  
Stretching Exercises

The shoulder joint is the most flexible joint in the human body which experiences high loads during certain sport activities involving overhead motion. Overhead athletes experience rapid shoulder elevation, abduction and external rotation during the movement and rapid deceleration after the movement, making them susceptible to shoulder injuries. Due to the extreme ranges of motion, overhead athletes tend to develop increased external rotation, combined with decreased range of internal rotation, emphasizing the need for balanced shoulder care program in the training process to prevent such occurrences. The aim of the research paper was to develop training regimen for injury prevention and shoulder maintenance that can be incorporated in daily training activities of the athletes in order to decrease the occurrence of injuries. Three part training program was designed consisting of specific warm up, strengthening and stabilization exercises and stretching exercises. The aim of the specific warm up was to prepare the shoulder for the training loads, mimicking the overhead movements and stimulating the stabilization in the joint. Strengthening and stabilization exercises aimed to strengthen external rotators in the shoulder and improve the stabilization of the shoulder joint by targeting specific muscles such as serratus anterior. The focus of stretching exercises was to stretch internal rotation muscles, which experience high loads in the overhead athlete's training. An effective training program that can be performed with minimal equipment and in a short time frame was designed to enable its simple incorporation into the daily training of overhead athletes.

scholarly journals Recurrent acromioclavicular joint dislocation with an associated coracoid fracture following acromioclavicular joint reconstruction

2020 ◽  
Vol 102 (6) ◽  
pp. e136-e140
Author(s):  
M Karia ◽  
N Al-Hadithy ◽  
G Tytherleigh-Strong
Keyword(s):  
Acromioclavicular Joint ◽  
High Strength ◽  
Shoulder Girdle ◽  
Coracoid Process ◽  
Acromioclavicular Joint Dislocation ◽  
Shoulder Injuries ◽  
Overhead Athletes ◽  
Joint Dislocations ◽  
Synthetic Ligament ◽  
Acromioclavicular Joint Instability

Acromioclavicular joint injuries are common and account for up to 12% of all shoulder girdle injuries and have been reported as being as high as 50% in sports-related shoulder injuries. While the majority of acromioclavicular joint dislocations can be treated non-operatively, there are certain injury configurations, which can include high-grade dislocations in overhead athletes, where surgery may be indicated. The surgical management of acromioclavicular joint instability has moved towards recreating the action of the coracoclavicular ligaments by resuspending the clavicle on to the coracoid. Multiple techniques using high-strength sutures, synthetic ligaments, tendon allografts or autografts passed either around or through the coracoid process have been described. However, an unusual, but significant, complication associated with these techniques is an iatrogenic fracture of the coracoid process. We report the case of a patient with an iatrogenic coracoid fracture following two failed acromioclavicular joint resuspensory reconstructions using a synthetic ligament. This injury was successfully treated with an autologous hamstring graft reconstruction, initially protected with a hook plate.

Effects of Rigid and Kinesio Taping on Shoulder Rotation Motions, Posterior Shoulder Tightness, and Posture in Overhead Athletes: A Randomized Controlled Trial

2019 ◽  
Vol 28 (3) ◽  
pp. 256-265 ◽  
Author(s):  
Damla Gulpinar ◽  
Sibel Tekeli Ozer ◽  
Sevgi Sevi Yesilyaprak
Keyword(s):  
Randomized Controlled Trial ◽  
Range Of Motion ◽  
Internal Rotation ◽  
Controlled Trial ◽  
Shoulder Injuries ◽  
Overhead Athletes ◽  
Randomized Controlled ◽  
Kinesio Taping ◽  
Posterior Shoulder ◽  
Posterior Shoulder Tightness

Context:Alterations in posture and motion patterns are thought to play a role in developing shoulder injuries in overhead athletes. Taping is widely used in the sporting population, but there are limited empirical data regarding its effectiveness.Objectives:To determine and compare the effects of rigid and kinesio taping on shoulder rotation motions, posterior shoulder tightness (PST), and posture in overhead athletes.Design:Randomized controlled trial.Setting:Athletic training rooms.Participants:Eighty-six asymptomatic elite overhead athletes.Interventions:Participants were randomly divided into 4 groups: rigid taping group (RTG) that underwent therapeutic rigid taping, kinesio taping group (KTG) that underwent therapeutic kinesio taping, placebo group that underwent placebo kinesio taping (shoulder and scapular region taping for taping groups), and control group (no taping).Main Outcome Measures:Shoulder rotation motions, PST, and head and shoulder posture were evaluated at baseline, immediately after application and 60 to 72 hours after application for all groups.Results:Glenohumeral internal rotation increased immediately (P < .001) and at 60 to 72 hours after application in the KTG (P = .01), whereas it decreased immediately after application in the RTG (P < .001). Immediately after application, total rotation range of motion increased in the KTG (P =.02) and decreased in the RTG (P < .001), and there was a difference between groups (P = .02). Immediately after application, PST increased in the RTG (P < .001); after 60 to 72 hours, it decreased in the KTG (P = .04) and increased in the RTG (P = .01). Posture outcomes did not change significantly (P > .05).Conclusions:Kinesio taping may improve and rigid taping may worsen glenohumeral internal rotation and PST in overhead athletes. For increasing total rotation range of motion, kinesio taping is superior to rigid taping. Taping did not affect posture. Short-term kinesio taping in overhead athletes may be useful to improve glenohumeral internal rotation, total rotation range of motion, and PST.

The Effect of Glenohumeral Internal-Rotation Deficit on Functional Rotator-Strength Ratio in Adolescent Overhead Athletes

2016 ◽  
Vol 25 (1) ◽  
pp. 52-57 ◽  
Author(s):  
Hande Guney ◽  
Gulcan Harput ◽  
Filiz Colakoglu ◽  
Gul Baltaci
Keyword(s):  
Adverse Effect ◽  
Internal Rotation ◽  
Outcome Measures ◽  
Cross Sectional Study ◽  
Shoulder Injuries ◽  
Cross Sectional ◽  
Overhead Athletes ◽  
Glenohumeral Internal Rotation Deficit ◽  
Significant Difference ◽  
The Difference

Context:Glenohumeral (GH) internal-rotation deficit (GIRD) and lower eccentric external-rotator (ER) to concentric internal-rotator (IR) strength (ER:IR) ratio have been documented as risk factors for shoulder injuries, but there is no information on whether GIRD has an adverse effect on ER:IR ratio in adolescent overhead athletes.Objectives:The aim of this study was to investigate the effects of GIRD on functional ER:IR ratio of the adolescent overhead athletes.Design:Cross-sectional study.Setting:University research laboratory.Participants:52 adolescent overhead athletes.Main Outcome Measures:To determine GIRD, the range of GH IR and ER motion was measured with a digital inclinometer. An isokinetic dynamometer was used to assess eccentric and concentric IR and ER muscle strength of the dominant and nondominant shoulders. One-way ANCOVA where sport type was set as a covariate was used to analyze the difference between athletes with and without GIRD.Results:After standardized examinations of all shoulders, the athletes were divided into 2 groups, shoulders with (n = 27) and without GIRD (n = 25). There was a significant difference between groups in functional ER:IR ratio (P < .001). Athletes with GIRD had lower ER:IR ratio (0.56) than athletes without GIRD (0.83).Conclusions:As GIRD has an adverse effect on functional ratio of the shoulder-rotator muscles, interventions for adolescent overhead athletes should include improving GH-rotation range of motion.

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