Injury history, kinetic chain may hold answers to athlete’s shoulder pain
PHILADELPHIA — To identify the source of shoulder pain in a throwing athlete, orthopedists should study the athlete’s injury history and kinetic chain, according to a presenter here.
In his presentation at the Advances in Throwing Symposium, Brian J. Sennett, MD, said when working with throwing athletes, orthopedists should understand the phases of throwing and where the athlete is having problems in the phases. However, orthopedists should not only focus on the examination, but inquire about any other recent injuries the patient has had, he added.
“If the kid says, ‘I sprained my ankle 5 months ago,’ and he is having difficulty with his ability to land on that ankle, [that] may be the source of all your problems,” Sennett said.
During an assessment of the patient’s kinetic chain, surgeons should also examine knee strength, hip range of motion, hip rotation and core strength, Sennett noted.
“When we look at hip motion, the best way to do it is being prone,” he said. “It stabilizes the pelvis and it allows us to look at external rotation and internal rotation ... and you have to measure both sides.”
According to Sennett, athletes should have symmetric range of motion, which has been shown to be a significant factor in professional athletes when it comes to shoulder injury.
In the upper extremity, orthopedists should focus on scapular position and the back of the shoulder, and check for scoliosis. The glenohumeral joint should have the same total arc of motion on both sides, he said.
“Now, it could be shifted potentially 10° on the throwing side—10° more external rotation, 10° less internal rotation—but your total arc of motion should be the same amount,” Sennett said. “When we have seen differences on total arcs of motions, that has been a prognosticor of problems, as well as having a glenohumeral internal rotation deficit.” – by Casey Tingle
Sennett BJ. Office exam of the throwing athlete. Presented at: Advances in Throwing: Latest on Injury Treatment and Performance Optimization Symposium; Jan. 27, 2018; Philadelphia.
Disclosure: Sennett reports no relevant financial disclosures.