This is the third expert-consensus update on the disabled throwing shoulder, covering anatomy and mechanics. It synthesizes current thinking on the labrum, biceps, kinetic chain, and range-of-motion adaptations in overhead throwers. The goal is a framework to separate normal throwing adaptations from true pathology.
When a thrower presents with shoulder pain, resist the urge to blame a single labral lesion. This consensus frames the disabled throwing shoulder as internal impingement driven by upstream deficits in the kinetic chain, scapula, and range of motion.
The practical rule: measure internal rotation, external rotation, and external rotation in forearm pronation on both arms. A GIRD over 20 degrees, a TRM difference outside 5 degrees, or an ER loss over 5 degrees flags a thrower at risk.
Many changes in the thrower's shoulder are adaptive, not pathologic. Surgical correction of adaptations can worsen outcomes, so conservative management of the whole chain comes first. Before considering biceps tenotomy or tenodesis, remember the biceps contributes to concavity compression and tension-band stability. In SLAP surgery, restore the posterior anchor first.
Screen stride length (target 80-85% of height) and avoid pitching through fatigue, which raises injury risk 36-fold.
This is the third expert-consensus update on the disabled throwing shoulder, covering anatomy and mechanics. It synthesizes current thinking on the labrum, biceps, kinetic chain, and range-of-motion adaptations in overhead throwers. The goal is a framework to separate normal throwing adaptations from true pathology.
When a thrower presents with shoulder pain, resist the urge to blame a single labral lesion. This consensus frames the disabled throwing shoulder as internal impingement driven by upstream deficits in the kinetic chain, scapula, and range of motion.
The practical rule: measure internal rotation, external rotation, and external rotation in forearm pronation on both arms. A GIRD over 20 degrees, a TRM difference outside 5 degrees, or an ER loss over 5 degrees flags a thrower at risk.
Many changes in the thrower's shoulder are adaptive, not pathologic. Surgical correction of adaptations can worsen outcomes, so conservative management of the whole chain comes first. Before considering biceps tenotomy or tenodesis, remember the biceps contributes to concavity compression and tension-band stability. In SLAP surgery, restore the posterior anchor first.
Screen stride length (target 80-85% of height) and avoid pitching through fatigue, which raises injury risk 36-fold.