The disabled throwing shoulder: spectrum of pathology-10-year update. [Part 2]
This is Part two of the summary by Willem-Paul posted on July 10.
Over the years, several roles have been attributed to the glenohumeral labrum, such as forming an attachment site for the long head of the biceps, deepening the glenohumeral socket and aiding in tensioning of the capsule. Recently, other functions have emerged in the literature, among others pressure distribution and providing proprioceptive feedback.
As a relatively low proportion of overhead athletes that have undergone SLAP lesion repairs actually achieves successful return-to-play, surgery should only be considered when adequate rehabilitation has failed – it should in fact be thought of as a last resort.
Rehabilitation is an import means of modifying the dysfunction and reducing the need for surgery. A whole body approach is recommended, in which the kinetic chain, shoulder mobility and arm strength and endurance should consecutively be addressed.
Focusing on deficits in the lower extremity and trunk is necessary, since acceleration of the elbow, wrist and eventually the ball depends largely on torques generated in the proximal part of the chain. Losses in internal rotation and total ROM should be treated in order to restore relatively safe ROM values and strength and endurance should be aimed at achieving proximal functional control before focusing on distal power. > From: Kibler et al., Arthroscopy 29 (2013) 141-161. All rights reserved to the Arthroscopy Association of North America.
The Pubmed summary of the article can be found here.
See the excessive external rotation / abduction stress on the shoulder joint during throwing in the high speed camera YouTube clip below.