New Paradigms in the Throwing Shoulder: Labral Injury, Surgery, and Rehabilitation

Knowledge regarding the importance of the superior labrum in shoulder function is evolving as biomechanical and clinical studies define the roles of the labrum in shoulder function and dysfunction. The diagnosis of the clinically significant labral injury, the alteration in labral anatomy that is associated with the production of clinical symptoms and dysfunction and requires management, is based on specific history and clinical examination findings that point to the loss of labral roles. Surgical management should address all aspects of the altered labral anatomy and repair the labral structure to allow normal labral roles without excessive biceps tension. It may be that the superior labral injury may be a normal variant in throwers, allowing the thrower to achieve optimum cocking in external rotation. Specific guidelines for intraoperative assessment of the labral injury and criteria for determining the adequacy of the repair may be followed. Emerging data suggest that approximately 50% of patients with a clinically significant labral injury can become asymptomatic with guided rehabilitation. Rehabilitation has specific goals to restore the demonstrated deficits, should be organized into specific phases based on the patient's injury and functional capability, and should have specific criteria to allow return to play.