Surgeons should re-establish kinetic chain in treatment of throwing athletes

Issue: May 2019

James P. Bradley

ORLANDO — When treating a shoulder injury in the throwing athlete, orthopedic surgeons should re-establish the athlete’s kinetic chain at every level, according to a presenter at the Arthroscopy Association of North America Annual Meeting.

In his presentation, James P. Bradley, MD, noted orthopedic surgeons should fix the posture of throwing athletes, make sure they have core stability and perform open- and closed-chain dynamic and functional stability testing to identify any balance issues. He added the athlete’s lumbo-pelvic-hip mobility affects scapular position, scapular kinematics, range of motion, external rotation torque and shoulder extension.

“You want to look for any type of postural problems, muscle problems, especially atrophy in the infraspinatus, which we see a lot in throwers,” Bradley said.

Bradley noted that the scapula is the essential link to maintaining a dynamically stable, reproducibly positioned platform for the glenohumeral joint.

“You have to have a good scapula. It maximizes the glenohumeral joint stability and transfer of motion to the arm,” Bradley said. “You got a bad scapula? You cannot throw.”

Surgeons need to review both active and passive shoulder motion and check for true abduction and flexion before performing internal and external rotation both at the side and overhead, according to Bradley.

“If you want to operate on a thrower’s shoulder, get an MRI; but if you get one, do not treat the MRI because they always have something wrong with them,” he said. – by Casey Tingle

Reference:

Bradley JP. Exam and pathomechanics of the throwing athlete. Presented at: Arthroscopy Association of North America Annual Meeting; May 2-4, 2019; Orlando.

Disclosure: Bradley reports he receives IP royalties from Arthrex Inc. and is a board or committee member for the American Orthopaedic Society for Sports Medicine and the Arthroscopy Association of North America.