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Medicina dello Sport 2002 December;55(4):287-97


language: Italian

The chronic painful shoulder in overhead athletes

Carretta A.

Scuola di Specializzazione in Medicina dello Sport, Servizio Speciale in Medicina dello Sport, Università degli Studi di Napoli “Federico II”, Napoli


Shoulder pain pathology, especially in overhead athletes, has in recent decades been the subject of steadily growing interest. This has led to a radical change in the clinico-diagnostic, therapeutic and rehabilitative criteria employed in this pathology. By the general term “thrower’s shoulder” is meant a chronic pain syndrome of the shoulder which affects certain categories of athletes and which presents the array of symptoms typical of scapulohumeral periarthritis. The pathology derives from functional overloading and the pathogenetic factor is reiterated microtrauma of the muscular insertions, particularly those of the rotator cuff (above all the supraspinatus) that often also involves the long head of the brachial biceps. Athletes who engage in so-called overhead sports (tennis, volleyball, basketball, hand-ball, swimming, water-polo, gymnastics, baseball, throwing) put their shoulders through considerable stress every time the upper extremity is stretched to the full in whatever particular movement is involved, namely when the extremity exceeds 90° elevation in the scapular plane. This is the main reason why this category of sportsmen and women is especially vulnerable to accidents such as bursitis, tendinitis, scapulohumeral conflict, shoulder instability and, in rare cases, peripheral neurological damage such as acute traction of the brachial plexus, lesion of the long thoracic nerve and suprascapular nerve entrapment. On the other hand, in “contact” sports (football, rugby, hockey, karate), other types of lesions, such as scapulohumeral and acromioclavicular luxation and clavicular fracture, are more common. Arthroscopy has made it possible to introduce new diagnostic and therapeutic criteria for the most frequent conditions causing thrower’s shoulder, namely scapulohumeral instability and rotator cuff pathology. In particular, study of specific lesions to the stabilisation system and the tendons has made it possible to make a sharp distinction between pain syndromes of so-called normal subjects who engage only occasionally in sporting activity, and syndromes which affect throwers who use their shoulders in a specific, repetitive manner for years. Arthroscopic investigation has had the effective merit of evidencing a clinical and anatomopathological situation that has thus far been misinterpreted and undervalued, namely that postero-superior glenoid conflict which is today unanimously recognised as the principal cause of chronic painful shoulder in throwers. Knowledge of this “new” pathology and its accurate diagnostic classification are essential for adequate treatment which is fundamentally of rehabilitative type and which aims to return the athlete to competitive activity as quickly as possible.

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