Meeting News

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.

Brian J. Sennett

“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

 

Reference:

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.

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.

Brian J. Sennett

“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

 

Reference:

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.

    Perspective

    Christopher S. Ahmad

    The recent presentation by Brian J. Sennett entitled “Office exam of the throwing athlete” highlights the extreme importance of the kinetic chain evaluation when treating a throwing athlete. Oftentimes, a pathologic condition to the shoulder or elbow can be traced back to a kinetic chain abnormality located anywhere from the thrower’s toe to his scapula. A current challenge for the sports medicine practitioner is taking the necessary time to perform an entire history and musculoskeletal exam when pressured to get through a busy day of patients. In addition, these assessments are best performed with functional movement tests that may not be possible in small exam rooms.
    The sports medicine practitioner should also pay special attention to modifiable problems in the kinetic chain. For example, lack of hip motion related to non-modifiable bone geometry (except with surgery) cannot be corrected with rest or therapeutic modalities. However, hip abductor weakness or periscapular muscle weakness can be corrected through a strengthening program.
    The sports medicine practitioner who fails to identify and correct kinetic chain abnormalities is analogous to an auto mechanic who changes worn tires on a car but fails to identify and correct poor wheel alignment. Unfortunately, the car will simply wear out the new tires and the throwing athlete will suffer recurrent injury, which could have been avoided.

    • Christopher S. Ahmad, MD
    • Head team physician New York Yankees
      Chief of sports medicine service
      Professor of orthopedic surgery
      Columbia University Medical Center
      New York City

    Disclosures: Ahmad reports no relevant financial disclosures.