Throwing
| Wind-up | Acceleration | Deceleration |
|---|---|---|
|
Cocking - external rotation up to 180o in pitcher |
Scapular muscles | |
Anatomy
Pitchers have increased humeral head retroversion
- adaptation of growth pate
- increased external rotation with decreased internal rotation
Pathology
Subcoracoid impingement
- biceps and subscapularis impingement against coracoid
- with arm in flexion / adduction / internal rotation
Subacromial impingement
- bursal sided partial thickness rotator cuff tears
Internal impingement
- posterior aspect of supraspinatus impinges on posterosuperior rim of glenoid / posterosuperior labrum
- classic 90 / 90 position
- late cocking / early acceleration phase
Internal Impingement
Definition
Impingement in external and abduction
Presents with posterior shoulder pain
Etiology
Posterior capsule tightness / contracture of the posterior IGHL
Anterior instability / micro-instability / pseudolaxity
- anterior capsular stretching with anterior translation humeral head
Pathology
Peel-back / injury to the posterosuperior labrum +/- SLAP
Examination
Posterior capsule tightness
- limited internal rotation
- normal in professional pitches
Anterior instability
- apprehension test
- shoulder in 90o abduction and 90o external rotation
- throwing position
- look carefully for anterior instability
MRI
Posterosuperior labral tear +/- SLAP
Partial rotator cuff tears
- articular side
- at supraspinatus / infraspinatus junction
Nonoperative management
Physiotherapy
Rotator cuff strengthening / scapular stabilizer strengthening
Stretching to reduce internal rotation tightness - sleeper stretch
Kinesio Taping
Gianola et al Cochrane Database 2021
- taping for rotator cuff disease
- 23 studies and 1000 patients
- taping may improve quality of life
Operative management
Technique
Debridement partial articular rotator cuff tears
Glenoplasty and posterosuperior labral repair
+/- anterior capsular plication