Presenter: Shoulder instability in repetitive overhead athletes amenable to rehabilitation
Click Here to Manage Email Alerts
WAIKOLOA, Hawaii — Identifying breaks in the kinetic chain and any glenohumeral internal rotation deficits can aid diagnosis of shoulder pain and instability in overhead athletes, a presenter said at Orthopedics Today Hawaii.
At the meeting, Xavier A. Duralde, MD, discussed some of the diagnosis and treatment challenges of shoulder instability in the repetitive overhead athlete.
“The stability of the shoulder in athletes varies in degree and direction. Patient demands differ according to the sports and the hand dominance. Evaluation is often nonspecific,” he said.
During his presentation, Duralde said the first test he performs in throwers who have shoulder pain when they throw is the single-leg stability test. “Often, if they’re imbalanced or weak in their pushoff leg, I can tell that their whole kinetic chain is starting improperly, they’re stressing their shoulder too much. You correct those problems, their shoulder pain goes away,” he said.
In the absence of gross instability, Duralde said no available test, including the presence of the sulcus sign, is specific enough to make a thorough diagnosis. “The history, the physical examination [and] radiograph paint a picture and you have to use your diagnostic skills to put it together to say what’s the problem,” he said.
Glenohumeral internal rotation deficit is common. Orthopedic surgeons should look for it among their initial findings, but also be prepared to deal with the many ”unspecific findings we see in overhead athletes,” Duralde said.
“Rehabilitation is the mainstay of our treatment,” he said, noting the starting point in most cases consists of controlling inflammation, regaining flexibility and regaining strength. In addition, a good rehabilitation program includes core strengthening, proprioceptive training, scapular stabilization, plyometrics and, for overhead throwers, ultimately a throwing program that increases flexibility and helps the player regain full range of motion without tenderness or pain, he said.
“Proprioception training and plyometrics are important for these players,” Duralde said.
Overall rates of treatment success vary, with about 40% of players with labral tears returning to play. Furthermore, success rates are better than that among patients who present before they develop a labral tear, he said.
Although surgical results reported in large case series show patients can achieve “reasonable” outcomes, Duralde said “surgery in these cases is a last option” and the rehabilitation period is long.
If surgery is required, surgeons should consider the patient’s activity level and treating all of the pathology to determine how much of each of those problems contributes to the instability, he said.
“You want to do a minimally invasive procedure, if possible,” Duralde said.
“What about the rotator cuff? Well, easy answer – leave it alone. If you repair it, they’re not going to return to play,” he said.
Collapse
Duralde XA. How I treat repetitive overhead athletes with instability. Presented at: Orthopedics Today Hawaii 2022. Jan. 9-13, 2022; Waikoloa, Hawaii.
Read more about
Click Here to Manage Email Alerts