The throwing shoulder

The shoulder is affected by numerous pathological conditions related to the high speeds and intra-articular stresses during the throwing movement. The most common are SLAP lesions and internal impingement. The treatment is preventive and conservative initially, starting in athletes at a young age and continuing throughout their entire sports career. It includes posterior capsule stretching, strengthening of the external rotators and scapular stabilizers, correcting any scapular dyskinesia and optimizing the static and dynamic balance of the thorax, pelvis and legs. Surgical treatment is considered after failure of conservative treatment. For SLAP lesions: repair may be proposed to high-level athletes younger than 35 years; biceps tenodesis is advised in other cases. For internal impingement: posterior glenoidoplasty with posterosuperior labral debridement, sometimes combined with posterosuperior capsulotomy is usually successful. However, an associated rotator cuff tear that needs repair will compromise the outcomes. In the throwing shoulder, one must keep in mind the possibility of other rare lesions, including capsular, musculotendinous, neurologic, and bone lesions. The objective of any treatment is to allow return to the previous level of sport, which can be evaluated by subjective scores specific to throwing sports (KJOC score). LEVEL OF EVIDENCE: > V; expert opinion.