Shoulder Injuries in the Overhead Athlete

Shoulder Injuries in the Overhead Athlete

Oversat SYNOPSIS
”Overhead” kaste bevægelsen er en ekstremt kompliceret bevægelse. Ved pitching, stiller sportsudøveren ekstraordinære krav til skulderen og skulderbæltet på grund af de enorme kræfter, der genereres. Kasterens skulder skal være eftergivelig nok til at tillade ekstrem udad rotation, men stabil nok til at forhindre subluxation af caput humeri, og dette kræver en fin balance mellem mobilitet og funktionel stabilitet. Dette benævnes "thrower's paradoks”. Denne balance er ofte kompromitteret og menes at føre til de forskellige typer af skader på det omgivende væv. Dette kan med held behandles med et non-operativt, godt struktureret og omhyggeligt gennemført rehabiliterings-program. Nøglen til succes med non-operative rehabilitering er en grundig klinisk undersøgelse og en præcis diagnose. Rehabiliteringen skal følge en struktureret, mangesidet tilgang med hovedvægt på at kontrollere inflammation, genoprette muskel balance, forbedre fleksibilitet, øge proprioception og den neuromuskulære kontrol, og dermed effektivt få sportsudøveren tilbage til elitekastning igen. Sportsudøvere udviser ofte mange adaptive ændringer i vævet på grund af de gentagne microtraumer, der forekommer ved ”overhead” kaste bevægelsen. Rehabiliteringen bør omfatte behandling af disse tilpasninger.

Kevin E. Wilk, Padraic Obma, Charles D. Simpson, E. Lyle Cain, Jeffrey R. Dugas, James R. Andrews

J Orthop Sports Phys Ther. 2009;39(2):38-54. doi:10.2519/jospt.2009.2929

DOI: 10.2519/jospt.2009.2929

SYNOPSIS
The overhead throwing motion is an extremely skillful and intricate movement. When pitching, the overhead throwing athlete places extraordinary demands on the shoulder complex subsequent to the tremendous forces that are generated. The thrower’s shoulder must be lax enough to allow excessive external rotation but stable enough to prevent symptomatic humeral head subluxations, thus requiring a delicate balance between mobility and functional stability. We refer to this as the "thrower’s paradox." This balance is frequently compromised and believed to lead to various types of injuries to the surrounding tissues. Frequently, injuries can be successfully treated with a well-structured and carefully implemented nonoperative rehabilitation program. The key to successful nonoperative treatment is a thorough clinical examination and accurate diagnosis. Rehabilitation follows a structured, multiphase approach, with emphasis on controlling inflammation, restoring muscles’ balance, improving soft tissue flexibility, enhancing proprioception and neuromuscular control, and efficiently returning the athlete to competitive throwing. Athletes often exhibit numerous adaptive changes that develop from the repetitive microtraumatic stresses occurring during overhead throwing. Treatment should include the restoration of these adaptations.
LEVEL OF EVIDENCE: Level 5.

KEYWORDS: baseball, glenohumeral joint, labral lesions, pitching, rotator cuff