Disabled Throwing Shoulder: 2021 Update: Part 2—Pathomechanics and Treatment

Proximal to distal sequencing impacts on maximum shoulder joint angles and the risk of impingement in baseball pitching involving a scapular independent thoracohumeral model

“…This finding partially supports the general notion that hyperangulation of the scapulohumeral joint due to poor coordination of the scapula during throwing motion is a major cause of internal impingement in baseball pitchers. 4,6,[12][13][14] As suggested repeatedly in literature, 4,7,29,[40][41][42] medical professionals should place high importance in maintaining proper range of motion at various joints, concentric and eccentric muscle strength and endurance, and coordination of the multi-segment link system within the torso and shoulder complex. Precise description of proximal-to-distal sequencing presented in this study provides quantitative evidence to support the most recent consensus statements in Disabled Throwing Shoulder 2021 that "the ultimate function of the kinetic chain is to optimize the launch window, the precise biomechanical time, and position for ball release 7 " and "rehabilitation should correct all kinetic chain deficits while also developing high-functioning, throwingspecific motor patterns".…”

“…Precise description of proximal-to-distal sequencing presented in this study provides quantitative evidence to support the most recent consensus statements in Disabled Throwing Shoulder 2021 that "the ultimate function of the kinetic chain is to optimize the launch window, the precise biomechanical time, and position for ball release 7 " and "rehabilitation should correct all kinetic chain deficits while also developing high-functioning, throwingspecific motor patterns". 40…”

Initial Assessment and Management of Select Musculoskeletal Injuries: A Team Physician Consensus Statement

“…Operative treatment • Surgery may be indicated in the failure of comprehensive nonoperative management and in the presence of specific clinical examination findings and confirmatory imaging. • The surgical procedure should address all shoulder pathology (e.g., superior, posterior, anterior labral, rotator cuff, biceps) and be followed by a comprehensive postoperative rehabilitation program (14).…”

“…In-season screening of the kinetic chain can assist in early recognition and injury prevention. • Advise caution if weighted ball programs and pitching programs based on increasing velocity are used, as both have been associated with increased risk of injury (14). It is essential the team physician understand • DTS may present as a decline in performance or as an injury.…”

Understanding the Disabled Throwing Shoulder Requires Updated Review of Anatomy, Mechanics, Pathomechanics, and Treatment

“…Part 1 e Anatomy and Mechanics; and Part 2 e Pathomechanics and Treatment by Kibler, Sciascia, Tokish, Kelly, Thomas, Bradley, Reinold, and Ciccotti. [23][24] Some of the greatest advances in sports medicine today result from our ability to visualize normal and pathologic anatomy of joints, including the shoulder, using a small camera and a fiberoptic light source, through small portals, and absent open surgical dissection, or, in a word, using "arthroscopy." 25 We are honored to share these advances in Arthroscopy.…”