[Assessment of shoulder pain in athletes]

The shoulder joint, the most movable joint in our body, is exposed to a considerable load during many sporting activities. The shoulder can be injured and limited in its function not only by direct and indirect trauma but also by repetitive load. Sports with body contact may cause bruises, glenohumeral and acromio-clavicular dislocations or strains of the rotator cuff. Any repetitive microtrauma, particularly those involving sporting activities requiring repetitive overhead use of the arm, may develop lesions of tendons, glenohumeral instabilities or impingement of the deep surface of the supraspinatus tendon on the posterosuperior glenoid rim and may be frequently the cause of shoulder pain in athletes. After an introduction to the anatomy of the shoulder and an illustration of the biomechanics of throwing, we explain shoulder pains in the athlete caused by tendon lesions, joint instability and by neurovascular shoulder problems with the typical patient history, the clinical signs, physical and imaging studies in detail. Among the typical lesion of tendons we are describing the impingement syndrome of the supraspinatus tendon, the lesions of the biceps tendon and the impingement of the lower surface of the cuff on the postero-superior glenoid labrum. As glenohumeral instability we describe the anterior, posterior, and inferior instability and the multidirectional instability as well. As neurovascular shoulder problems we describe anatomy, function, patient history, etiology, clinical signs, physical examination, differential diagnosis, therapy, and prognosis of lesions of the nervi suprascapularis, axillaris, thoracicus longus, musculocutaneus, and accessorius as well as lesions of the plexus brachialis and in the thoracic outlet syndrome.