The Disabled Throwing Shoulder: Spectrum of Pathology—10-Year Update

Kibler, W. Ben; Kuhn, John E.; Wilk, Kevin E.; Sciascia, Aaron; Moore, Stephanie D.; Laudner, Kevin G.; Ellenbecker, Todd S.; Thigpen, Chuck; Uhl, Timothy L.

doi:10.1016/j.arthro.2012.10.009

Cited by 231 publications

(234 citation statements)

References 208 publications

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“…Researchers 28 recently reported that poor portal placement during primary superior labral repair can result in fullthickness rotator cuff tears of the supraspinatus. Anchor quantity and placement and portal placement are thought to contribute to restoration of labral function 29 and are necessary information for critically analyzing outcomes, such as patient satisfaction and return to participation.…”

Section: Surgical Considerationsmentioning

confidence: 99%

Return to Preinjury Levels of Participation After Superior Labral Repair in Overhead Athletes: A Systematic Review

Sciascia¹,

Myers

Kibler³

et al. 2015

Journal of Athletic Training

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Context Athletes often preoperatively weigh the risks and benefits of electing to undergo an orthopaedic procedure to repair damaged tissue. A common concern for athletes is being able to return to their maximum levels of competition after shoulder surgery, whereas clinicians struggle with the ability to provide a consistent prognosis of successful return to participation after surgery. The variation in study details and rates of return in the existing literature have not supplied clinicians with enough evidence to give overhead athletes adequate information regarding successful return to participation when deciding to undergo shoulder surgery. Objective To investigate the odds of overhead athletes returning to preinjury levels of participation after arthroscopic superior labral repair. Data Sources The CINAHL, MEDLINE, and SPORTDiscus databases from 1972 to 2013. Study Selection The criteria for article selection were (1) The study was written in English. (2) The study reported surgical repair of an isolated superior labral injury or a superior labral injury with soft tissue debridement. (3) The study involved overhead athletes equal to or less than 40 years of age. (4) The study assessed return to the preinjury level of participation. Data Extraction We critically reviewed articles for quality and bias and calculated and compared odds ratios for return to full participation for dichotomous populations or surgical procedures. Data Synthesis Of 215 identified articles, 11 were retained: 5 articles about isolated superior labral repair and 6 articles about labral repair with soft tissue debridement. The quality range was 11 to 17 (42% to 70%) of a possible 24 points. Odds ratios could be generated for 8 of 11 studies. Nonbaseball, nonoverhead, and nonthrowing athletes had a 2.3 to 5.8 times greater chance of full return to participation than overhead/throwing athletes after isolated superior labral repair. Similarly, nonoverhead athletes had 1.5 to 3.5 times greater odds for full return than overhead athletes after labral repair with soft tissue debridement. In 1 study, researchers compared surgical procedures and found that overhead athletes who underwent isolated superior labral repair were 28 times more likely to return to full participation than those who underwent concurrent labral repair and soft tissue debridement (P < .05). Conclusions The rate of return to participation after shoulder surgery within the literature is inconsistent. Odds of returning to preinjury levels of participation after arthroscopic superior labral repair with or without soft tissue debridement are consistently lower in overhead/throwing athletes than in nonoverhead/nonthrowing athletes. The variable rates of return within each group could be due to multiple confounding variables not consistently accounted for in the articles.

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Section: Surgical Considerationsmentioning

confidence: 99%

Return to Preinjury Levels of Participation After Superior Labral Repair in Overhead Athletes: A Systematic Review

Sciascia¹,

Myers

Kibler³

et al. 2015

Journal of Athletic Training

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“…Addressing the dyskinesis has been shown to decrease impingement symptoms [ 38 ], improve rotator cuff strength [ 39 ], and decrease symptoms in labral injury [ 40 ].…”

Section: Scapular Dyskinesismentioning

confidence: 99%

The Overhead Athlete

Kibler

Kuhn

Sciascia

et al. 2013

Shoulder Arthroscopy

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“…Myers et al 16 found a GIRD of 19.7° in throwers with pathologic internal impingement; similarly, Wilk et al 24 reported a GIRD of 18°, which correlated to a 1.9-fold increase in injury risk. Based on these studies, Kibler et al 9 have reported GIRD to be a loss of 18° or greater of IR in the throwing shoulder compared to the T T SYNOPSIS: Stretching techniques that focus on increasing posterior shoulder soft tissue flexibility are commonly incorporated into prevention and treatment programs for the overhead athlete. The cross-body and sleeper stretch exercises have been described as stretching techniques to improve posterior shoulder soft tissue flexibility and to increase glenohumeral joint internal rotation and horizontal adduction range of motion in the overhead athlete.…”

Section: Common Characteristicsmentioning

confidence: 99%

“…Because the exact tissue that causes the pathophysiological loss in shoulder mobility in this population varies between osseous adaptations, posterior capsular tightness, musculotendinous tightness, and postural (scapular) adaptations, it is important that the clinician continually assess and adjust the treatment strategies as deemed appropriate. 9 The goal of this commentary is to provide the treatment strategies and rationale for maintaining optimal shoulder mobility in the overhead athlete. Clinically, the authors have found these stretching techniques to be extremely beneficial to improving IR of the shoulder in the overhead throwing athlete, without increasing shoulder symptoms.…”

Section: Summary Mmentioning

confidence: 99%

The Modified Sleeper Stretch and Modified Cross-body Stretch to Increase Shoulder Internal Rotation Range of Motion in the Overhead Throwing Athlete

Wilk¹,

Hooks²,

Macrina³

2013

Journal of Orthopaedic & Sports Physical Therapy

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Synopsis Stretching techniques that focus on increasing posterior shoulder soft tissue flexibility are commonly incorporated into prevention and treatment programs for the overhead athlete. The cross-body and sleeper stretch exercises have been described as stretching techniques to improve posterior shoulder soft tissue flexibility and to increase glenohumeral joint internal rotation and horizontal adduction range of motion in the overhead athlete. But, based on the inability to stabilize the scapula and control glenohumeral joint rotation with the cross-body stretch and the potential for subacromial impingement with the sleeper stretch, the authors recommend modifications to both of these commonly performed stretches. This clinical commentary reviews the literature on posterior shoulder stretches, describes modifications to both of these commonly performed stretches, and outlines a strategy to maintain or improve posterior shoulder soft tissue flexibility and glenohumeral joint internal rotation range of motion in the overhead athlete. Level of Evidence Therapy, level 5. J Orthop Sports Phys Ther 2013;43(12):891–894. Epub 30 October 2013. doi:10.2519/jospt.2013.4990

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The Disabled Throwing Shoulder: Spectrum of Pathology—10-Year Update

Cited by 231 publications

References 208 publications

Return to Preinjury Levels of Participation After Superior Labral Repair in Overhead Athletes: A Systematic Review

Return to Preinjury Levels of Participation After Superior Labral Repair in Overhead Athletes: A Systematic Review

The Overhead Athlete

The Modified Sleeper Stretch and Modified Cross-body Stretch to Increase Shoulder Internal Rotation Range of Motion in the Overhead Throwing Athlete

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