Anterior instability in the throwing shoulder

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Biomechanics

Background:

• Throwing athletes often experience shoulder disability due to glenohumeral joint laxity, which can progress to instability.
• Instability presents as traumatic anterior instability or overuse-induced anterior subluxation.
• Determining excessive laxity can be challenging, necessitating a cautious approach by physicians.

Purpose of the Study:

• To explore the multifactorial nature of the disabled throwing shoulder.
• To outline diagnostic and treatment considerations for anterior instability in throwing athletes.
• To review surgical techniques for managing anterior instability in this population.

Main Methods:

• Review of literature on shoulder instability in throwing athletes.
• Discussion of clinical presentation, diagnostic challenges, and conservative management strategies.
• Analysis of surgical interventions for traumatic and overuse-related anterior instability.

Main Results:

• Conservative management, including rest, rehabilitation, and correction of multifactorial issues (hip, core, scapular, biomechanics), is the primary treatment.
• Surgical management depends on the injury mechanism, with techniques focusing on labral and capsular repair.
• Arthroscopic techniques have evolved from early open procedures for anterior capsulolabral reconstruction.

Conclusions:

• Disabled throwing shoulder requires a comprehensive, multifactorial treatment approach.
• Conservative management should precede surgical considerations.
• Understanding the mechanism of injury is key to successful surgical management of anterior instability in throwing athletes.