Evaluation and management of shoulder instability in the elite overhead thrower

The elite throwing athlete places significant forces on the soft-tissue stabilizers of the shoulder with every pitch. Anterior translation forces can be as high as 40% of body weight and distraction forces as high as 80% body weight during the act of throwing. Injury to the static and dynamic stabilizers can lead to significant pain and loss of function in these athletes. To successfully treat the injured thrower, it is important to accurately diagnose the pathologic process. This article reviews the biomechanics of throwing and pathologic processes seen in the elite thrower. We cover the essentials of the history and physical in this population and conclude with a discussion of the various treatment regimens.