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Overhead athlete rehabilitation

Brandon J Erickson, Nina Petronico, Anthony A Romeo
PURPOSE OF REVIEW: Tears of the latissimus dorsi and teres major are uncommon but significant injuries, most frequently seen in high-level, overhead throwing athletes. Diagnosis can be challenging, as there are no pathognomonic signs, symptoms, or physical exam findings associated with latissimus dorsi/teres major tears, and the clinician must have a high suspicion for this injury. While many of these tears can be treated non-operatively, a subset of these benefits from surgical intervention...
February 1, 2019: Current Reviews in Musculoskeletal Medicine
Eric St-Onge, Andrew Robb, Tyson A C Beach, Samuel J Howarth
The Turkish Get-Up (TGU) is a complex and multi-planar exercise; the performer begins in a supine lying position, progresses toward upright standing through a series of 7 stages while holding a mass overhead in one hand, and returns to the original supine lying position through a reversal of the same 7 stages. A descriptive analysis of shoulder muscle activity during the TGU may provide insight toward its use in training and rehabilitation contexts. Our objectives were to: (1) describe the activity patterns from a subset of muscles that span the glenohumeral joint during individual stages of the TGU, and (2) interpret these patterns through comparisons between left- and right-side muscles, and between the up and down phases of the TGU...
January 2019: Journal of Bodywork and Movement Therapies
William T Wilson, Graeme P Hopper, Paul A Byrne, Gordon M MacKay
The ulnar collateral ligament (UCL) is the primary restraint to valgus angulation at the elbow. Injury to the UCL is increasingly common and can lead to instability, especially in athletes involved in overhead throwing. Conventional treatment is reconstruction using tendon autograft but performance levels are often restricted after long periods of rehabilitation. Modern surgical techniques have led to renewed interest in repair of the ligament, with the aim of restoring native anatomy. This has the benefit of retained proprioception and no graft harvest morbidity...
December 19, 2018: BMJ Case Reports
Mojtaba Babaei-Mobarakeh, Amir Letafatkar, Amir Hosein Barati, Zohre Khosrokiani
BACKGROUND: Rehabilitation of injuries in the upper extremity and reestablishment of muscle strength throughout the range of motion in overhead movements, are the major concerns of athletes and coaches in the sports field. PURPOSE: To determine the effect of eight-week "gyroscopic device" mediated resistance training exercise on grip strength, wrist and shoulder strength and proprioception, and upper extremity performance, in participants with impingement syndrome or tennis elbow...
October 2018: Journal of Bodywork and Movement Therapies
Shelby R Smith, Nirav K Patel, Alex E White, Christopher J Hadley, Christopher C Dodson
Background: Stress fractures of the elbow are rare in throwing athletes and present a challenge from both a management and rehabilitation perspective. Although the incidence of stress fractures of the elbow is increasing, there is a lack of data in the literature focused on throwers. Purpose: To evaluate studies regarding the management and outcomes of stress fractures of the elbow in throwing athletes. Study Design: Systematic review; Level of evidence, 4...
October 2018: Orthopaedic Journal of Sports Medicine
Gihan Shantha Jayasinghe
Scapula dyskinesis is prevalent in athletes conducting forceful overhead movements. This review summarizes our current understanding of the condition and evaluates the different options for assessing dyskinesis. Current methods for assessing scapula dyskinesis involve clinical observations, three-dimensional kinematics and three-dimensional wing computer tomography. Clinical observation is the most pragmatic method for assessing dyskinesis yielding inter-rater agreement of 79% and sensitivity of 76%. Similar sensitivities have been recorded using three-dimensional kinematics...
October 2018: Current Sports Medicine Reports
Christopher L McCrum, Joanna Costello, Kentaro Onishi, Chris Stewart, Dharmesh Vyas
Background: Ulnar collateral ligament (UCL) injury is a well-described etiology of pain and decreased performance for the overhead athlete. Despite a growing volume of literature regarding the treatment of these injuries for overhead athletes, there is a paucity of such data regarding stickhandling collision sport athletes, such as ice hockey players. Purpose/Hypothesis: The purpose of this study was to characterize this injury among 3 elite ice hockey players and to describe the ability of these athletes to return to play, as well as to review the unique sport-specific implications of this injury, evaluation, nonsurgical management, and considerations for return to play...
August 2018: Orthopaedic Journal of Sports Medicine
Michael A Stone, Omid Jalali, Ram K Alluri, Paul R Diaz, Reza Omid, Seth C Gamradt, James E Tibone, Erik N Mayer, Alexander Weber
Repetitive overhead throwing generates tremendous demands on the shoulder joint of the overhead athlete. Clinicians, therapists, and medical staff are charged with optimizing a throwing athlete's shoulder mobility and stability to maximize performance and prevent injury. Modifiable risk factors such as strength asymmetry, glenohumeral range of motion deficits, and scapulothoracic joint abnormalities contribute to the overhead athlete's predisposition to shoulder injury. Most shoulder injuries in the overhead thrower can be successfully treated nonoperatively to allow in-season return to sport...
April 2018: International Journal of Sports Physical Therapy
Jeff T Wight, Guy B Grover, John W Chow, Paul A Borsa, Erik A Wikstrom, Mark D Tillman
OBJECTIVES: 1) Thoroughly assess shoulder flexibility by establishing the passive torque-angle relationship for internal and external rotation with the arm in an overhead athletics position (abducted 90°) and 2) test the reliability of four passive torque-angle measures. DESIGN: Reliability study. SETTING: Data were collected in a university biomechanics laboratory. PARTICIPANTS: Bilateral shoulder flexibility of 15 male college students (20...
September 2018: Physical Therapy in Sport
D Müller, Y Reinig, R Hoffmann, M Blank, F Welsch, U Schweigkofler, T Stein
PURPOSE: Traumatic high-grade acromioclavicular joint (ACJ) separations can be surgically stabilized by numerous anatomic and non-anatomic procedures. The return to sport (Maffe et al. in Am J Sports Med 23:93-98, 1995] and remaining sport-associated impairments after acute ACJ stabilization has not yet been investigated. METHODS: 73 consecutive athletes with acute high-grade ACJ separation were prospectively assigned into two groups (64.4% randomized, 35.6% intention-to-treat): open clavicular hook plate (cHP) implantation (GI) or arthroscopically assisted double double-suture-button (dDSB) implantation (GII)...
July 6, 2018: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
David A Krause, Lucas G Dueffert, Jaclyn L Postma, Eric T Vogler, Amy J Walsh, John H Hollman
BACKGROUND: External rotation (ER) strengthening of the shoulder is an integral component of rehabilitative and preventative programs for overhead athletes. A variety of shoulder ER strengthening exercises are reported, including those intended to integrate the core musculature. The purpose of this study was to examine ER torque and electromyographic (EMG) activation of shoulder and trunk muscles while performing resisted isometric shoulder ER in 3 positions (standing, side lying, and side plank)...
July 2018: Sports Health
Lori A Michener, Jeffrey S Abrams, Kellie C Huxel Bliven, Sue Falsone, Kevin G Laudner, Edward G McFarland, James E Tibone, Charles A Thigpen, Timothy L Uhl
OBJECTIVE:   To present recommendations for the diagnosis, management, outcomes, and return to play of athletes with superior labral anterior-posterior (SLAP) injuries. BACKGROUND:   In overhead athletes, SLAP tears are common as either acute or chronic injuries. The clinical guidelines presented here were developed based on a systematic review of the current evidence and the consensus of the writing panel. Clinicians can use these guidelines to inform decision making regarding the diagnosis, acute and long-term conservative and surgical treatment, and expected outcomes of and return-to-play guidelines for athletes with SLAP injuries...
March 2018: Journal of Athletic Training
Terrance A Sgroi, Michelle Cilenti
PURPOSE OF REVIEW: With improvements in surgical techniques and increased knowledge of rotator cuff healing, there was a need to identify a safe progression after rotator cuff repair. The rehabilitation specialist plays an integral role in the care of these patients, and by implementing an evidence and criteria-based model, patients may be able to return to their prior levels of function sooner with fewer complications. RECENT FINDINGS: Timing of progression for rotator cuff patients should align not only with healing but also potential strain on the involved tissue...
March 2018: Current Reviews in Musculoskeletal Medicine
Corbin A Hedt, S Brett Holland, Bradley S Lambert, Joshua D Harris, Patrick C McCulloch
CONTEXT: Interval throwing programs (ITP) have long been used in the physical therapy setting to aid in the safe and efficacious return to sport for an overhead athlete. However, the overall utilization and variation of interval throwing programs are unknown in the physical therapy setting leading to potential inconsistencies in treatment paradigms. OBJECTIVE: To determine if differences in practice patterns exist among active physical therapists of various experience levels with regards to years of experience and advanced certifications...
January 24, 2018: Journal of Sport Rehabilitation
Jacob G Calcei, Venkat Boddapati, David W Altchek, Christopher L Camp, Joshua S Dines
PURPOSE OF REVIEW: This review discusses the diagnostic and treatment challenges presented by injuries to the biceps and superior labral complex. RECENT FINDINGS: A focused patient history, numerous physical examination maneuvers, and appropriate advanced imaging studies must be utilized to reach an accurate diagnosis. Nonoperative management, even in overhead athletes, has demonstrated relatively good outcomes, while operative outcomes have yielded mixed results...
March 2018: Current Reviews in Musculoskeletal Medicine
Kenneth M Lin, Evan W James, Elad Spitzer, Peter D Fabricant
PURPOSE OF REVIEW: The purpose of this review is to discuss the epidemiology, pathoanatomy, diagnosis, and clinical management of pediatric and adolescent patients following a first-time shoulder dislocation. RECENT FINDINGS: Shoulder instability is becoming increasingly common as pediatric and adolescent patients engage in earlier organized sports competition. Recommended treatment following a first-time glenohumeral dislocation event in adolescents depends on several factors, but surgical stabilization is becoming more frequently performed...
February 2018: Current Opinion in Pediatrics
Sam Bennett, Chris Macfarlane, Brett Vaughan
Rotator cuff dysfunction is common in athletes involved with overhead sports. Secondary subacromial impingement is a common cause of pain for patients with rotator cuff dysfunction. Exercise rehabilitation and manual therapy can be used in the treatment of subacromial impingement to decrease pain, increase functionality and support a return to activity. The current case report describes a 24-year-old patient with supraspinatus tendinosis and secondary subacromial impingement who was experiencing pain when playing tennis, and during daily activities involving overhead movements...
September 2017: Explore: the Journal of Science and Healing
Mia Smucny, Robert W Westermann, Matthew Winters, Mark S Schickendantz
Medial ulnar collateral ligament (UCL) injuries have become increasingly prevalent in overhead athletes. The orthopaedic literature contains a wealth of information on operative management of these injuries. However, there are few high-quality longitudinal studies on non-operative care of UCL injuries. The purpose of this review is to describe the non-operative approach to managing UCL injuries, including recommended rehabilitation strategies and predictors of successful non-operative treatment.
September 2017: Physician and Sportsmedicine
Philipp Ahrens, Frank Martetschläger, Sebastian Siebenlist, Johann Attenberger, Moritz Crönlein, Peter Biberthaler, Ulrich Stöckle, Gunther H Sandmann
BACKGROUND: Humeral head fractures requiring surgical intervention are severe injuries, which might affect the return to sports and daily activities. We hypothesize that athletic patients will be constrained regarding their sporting activities after surgically treated humeral head fractures. Despite a long rehabilitation program physical activities will change and an avoidance of overhead activities will be noticed. METHODS: Case series with 65 Patients, with a minimum follow-up of 24 months participated in this study...
April 26, 2017: BMC Musculoskeletal Disorders
Alexis A Wright, Eric J Hegedus, Daniel T Tarara, Samantha C Ray, Steven L Dischiavi
OBJECTIVE: To produce a best evidence synthesis of exercise prescription used when treating shoulder pathology in the overhead athlete. DESIGN: A systematic review of exercises used in overhead athletes including case studies and clinical commentaries. DATA SOURCES: MEDLINE, PubMed, SPORTDiscus and CINAHL from database inception through July 8, 2016. METHODS: We examined data from randomised controlled trials and prospective cohort (level I-IV evidence) studies that addressed exercise intervention in the rehabilitation of the overhead athlete with shoulder pathology...
February 2018: British Journal of Sports Medicine
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