The disabled throwing shoulder: spectrum of pathology Part I: pathoanatomy and biomechanics

Abstract

PROLOGUE: Several years ago, when we began to question microinstability as the universal cause of the disabled throwing shoulder, we knew that we were questioning a sacrosanct tenet of American sports medicine. However, we were comfortable in our skepticism because we were relying on arthroscopic insights, clinical observations, and biomechanical data, thereby challenging unverified opinion with science. In so doing, we assembled a unified concept of the disabled throwing shoulder that encompassed biomechanics, pathoanatomy, kinetic chain considerations, surgical treatment, and rehabilitation. In developing this unified concept, we rejected much of the conventional wisdom of microinstability-based treatment in favor of more successful techniques (as judged by comparative outcomes) that were based on sound biomechanical concepts that had been scientifically verified. Although we have reported various components of this unified concept previously, we have been urged by many of our colleagues to publish this information together in a single reference for easy access by orthopaedic surgeons who treat overhead athletes. We are grateful to the editors of Arthroscopy for allowing us to present our view of the disabled throwing shoulder. Part I: Pathoanatomy and Biomechanics is presented in this issue. Part II: Evaluation and Treatment of SLAP Lesions in Throwers will be presented in the May-June issue. Part III: The "SICK" Scapula, Scapular Dyskinesis, the Kinetic Chain, and Rehabilitation will be presented in the July-August issue. We hope you find it thought-provoking and compelling.