This is Part 2 of a 2021 expert consensus on the disabled throwing shoulder. It covers the pathomechanics, surgical indications, rehabilitation, and injury-risk strategies for the overhead athlete. The central shift is away from a SLAP-centric model toward the concept of a clinically significant labral injury that can occur anywhere on the glenoid.
When you evaluate a thrower with a dead arm, resist the reflex to blame the superior labrum. This consensus establishes that posterior labral injury is the most common clinically significant lesion, and MRI superior labral findings correlate poorly with symptoms.
Build a mental model of the labrum as two structures: a superior tension band (biceps-anchored) and a posteroinferior compression bumper. Symptoms arise when a tear propagates and destroys both, producing microinstability.
The key surgical pitfall is overconstraint. Anchors placed within 1 cm of the biceps base or above 10:30, or capsular imbrication, block the external rotation a thrower needs and worsen GIRD. Distinguish anatomic GIRD (internal rotation loss with symmetric total ROM, normal) from pathologic GIRD (internal rotation loss >18-20° with total ROM loss >5°).
Most importantly, overuse is the dominant modifiable risk factor. Track workload and avoid spikes above an ACWR of 1.27.
This is Part 2 of a 2021 expert consensus on the disabled throwing shoulder. It covers the pathomechanics, surgical indications, rehabilitation, and injury-risk strategies for the overhead athlete. The central shift is away from a SLAP-centric model toward the concept of a clinically significant labral injury that can occur anywhere on the glenoid.
When you evaluate a thrower with a dead arm, resist the reflex to blame the superior labrum. This consensus establishes that posterior labral injury is the most common clinically significant lesion, and MRI superior labral findings correlate poorly with symptoms.
Build a mental model of the labrum as two structures: a superior tension band (biceps-anchored) and a posteroinferior compression bumper. Symptoms arise when a tear propagates and destroys both, producing microinstability.
The key surgical pitfall is overconstraint. Anchors placed within 1 cm of the biceps base or above 10:30, or capsular imbrication, block the external rotation a thrower needs and worsen GIRD. Distinguish anatomic GIRD (internal rotation loss with symmetric total ROM, normal) from pathologic GIRD (internal rotation loss >18-20° with total ROM loss >5°).
Most importantly, overuse is the dominant modifiable risk factor. Track workload and avoid spikes above an ACWR of 1.27.