Clinical and arthroscopic findings in recreationally active patients (original) (raw)

Current concepts in shoulder examination of the overhead athlete

Examination of the shoulder complex has long been described as challenging. This is particularly true in the examination of the overhead athlete who has structural differences when compared to a shoulder patient who is a non-athlete. Complexity with the examination is due to unique biomechanical and structural changes, multiple joint articulations, multiple pain patterns, and the potential of injury to structures both inside (intra-articular) and outside (extra-articular) the glenohumeral joint. Repetitive stresses placed on the shoulders of overhead athletes may affect range of motion, strength, scapular position, and ultimately, the integrity of soft tissue and bony structures in any of the joints that comprise the shoulder complex. Furthermore, many shoulder examination tests thought to be unique to a single structure, joint, or condition can be positive in multiple conditions. The examination of the overhead athletes shoulder, coupled with a thorough medical history will provide a solid foundation to allow a functional physical therapy diagnosis and provide clues as to the presence of the lesion (s) causing disability. The purpose of this clinical commentary is to assist the reader to understand the unique physical characteristics of the overhead athlete, which will lead to a more accurate and reproducible evaluation of athletes who sustain injuries while participating in overhead sports.

Differential diagnosis of shoulder injuries in sports

2000

The shoulder is very susceptible to injury in sports. Its use as a battering ram in collision sports, frequent falls and direct blows, and the demanding combination of power, flexibility and repetition in overhand sports make this joint highly vulnerable. The complex anatomy of the shoulder creates a challenge for the clinician faced with an injury, be it chronic or acute, and many symptoms overlap. Chronic symptoms are often vague and nonspecific, highlighting the importance of a careful history and physical examination. This review article looks at various shoulder injuries that are relevant to sports, and discusses their differential diagnosis.

Intraarticular Abnormalities in Overhead Athletes Are Variable

2012

Background The cause of shoulder pain and dysfunction in the overhead athlete can be variable. Several studies illustrate the wide variety of lesions seen at the time of arthroscopy in overhead athletes who require surgery but it is unclear whether these differ by sport. Questions/purposes We examined overhead athletes with shoulder dysfunction to determine (1) the range of arthroscopically visualized shoulder abnormalities with specific attention to the posterosuperior glenohumeral joint and the rotator cuff; and (2) the relationship of sport type to these abnormalities. Methods We reviewed our institution's database for professional and collegiate athletes in overhead sports who, from 1996 through 2010, had diagnostic shoulder arthroscopy for insidious, nontraumatic, persistent pain and inability to participate in their sport. A descriptive analysis of the arthroscopic findings from 51 consecutive patients (33 males, 18 females; mean age, 25 years; range, 15-59 years) was done. We analyzed the arthroscopic findings with respect to sport using analysis of variance and Fisher's exact test. Results There was a wide range of superior labrum, posterosuperior glenoid, and rotator cuff abnormalities. Overall, the most frequent abnormalities were posterosuperior glenohumeral joint changes. Swimmers had fewer intraarticular abnormalities than baseball players. Conclusions We found a wide spectrum of intraarticular abnormalities in the shoulder of overhead athletes with shoulder pain requiring surgery. Additional study is needed to determine whether these abnormalities or combinations relate to specific athletic movements.

An arthroscopic and electromyographic study of painful shoulders in elite gymnasts

Knee Surgery Sports Traumatology Arthroscopy, 1996

Shoulder problems are common in overhead sports like baseball, basketball and volleyball. Although gymnastics also includes overhead activities, there are few reports about shoulder problems in this sports activity. During the time period 1992–1995 we treated five young competitive gymnasts for shoulder pain. Arthroscopy revealed that they were all suffering from SLAP lesions or other labral pathology, although they had never dislocated their shoulders. These injuries have not been described earlier in connection with gymnastics. In a survey of 13 gymnasts in an elite club, we found that six (46%) complained about shoulder pain. Since four of these athletes explained that their shoulder pain started acutely during ring exercises in suspension while one suffered a slower onset with pain also during parallel bar exercises, we undertook an electromyographic study of the shoulder musculature of three normal elite gymnasts during exercises on the parallel bars and rings. We found that during the ring exercises in suspension there was a “critical phase” during which the muscle activity around the shoulder was very low, leading to great articular stresses. This might explain the occurrence of labral lesions like the SLAP lesions in this type of athlete. If shoulder pain in elite gymnasts does not respond to rest and physical therapy over 2–3 months, a shoulder arthroscopy should be considered.

Clinical and diagnostic tests for shoulder disorders: a critical review

2010

The shoulder is one of the most complex joints in the human body and, as such, presents an evaluation and diagnostic challenge. The fi rst steps in its evaluation are obtaining an accurate history and physical examination and evaluating conventional radiography. The use of other imaging modalities (eg, ultrasound, magnetic resonance imaging and computed tomography) should be based on the type of additional information needed. The goals of this study were to review the current limitations of evidence-based medicine with regard to shoulder examination and to assess the rationale for and against the use of diagnostic physical examination tests.

Clinical tests in shoulder examination: how to perform them

British Journal of Sports Medicine, 2010

Background This article describes the best clinical tests of shoulder function and injury as identifi ed in a recent systematic review published in the British Journal of Sports Medicine. Discussion A description of the different tests is given, with photographs of the exact test procedure.