Abstract
Superior labral pathology is an exceedingly common entity among throwers, and in recent years, a number of reports have elucidated the prevalence of posterior glenohumeral instability among overhead athletes (baseball, softball, volleyball.) However, within this unique patient population, these conditions should not be viewed as separate clinical entities, but, rather as findings that exist on a single pathomechanic spectrum. In 2020, we now know that the complexity of the symptomatic thrower’s shoulder is a consequence of the complex anatomic relationships between the biceps tendon, capsulolabral tissues, posterosuperior rotator cuff, and the glenoid. In 2003, Burkhart et al. noted that diminished glenohumeral range of motion (i.e. glenohumeral internal rotation deficit “GIRD”) was common among throwers with painful shoulders. These authors further described a posterior-inferior capsular contracture as the “essential lesion” in the development of diminished range of motion in conjunction with impingement of the supraspinatus tendon between the greater tuberosity and the posterior-superior labrum (“pathologic internal impingement”) [1,2]. It is this internal impingement that so often manifests as partial thickness, articular sided supraspinatus tears in the throwing athlete. But these findings are now perhaps better understood as sequelae of a number of anatomic factors, including humeral retrotorsion, contractures of the coracohumeral ligament, pectoralis, and anterior deltoid, as well as dynamic muscle stiffness that can occur in response to the repetitive strains involved in overhead throwing.
Highlights
Superior labral pathology is an exceedingly common entity among throwers, and in recent years, a number of reports have elucidated the prevalence of posterior glenohumeral instability among overhead athletes within this unique patient population, these conditions should not be viewed as separate clinical entities, but, rather as findings that exist on a single pathomechanic spectrum
The labrum does not have a consistent anatomy around the entire glenoid face, as the superior labrum is more loosely attached to the glenoid margin, and, is more mobile throughout the range of motion during overhead activities [3]
The throwing shoulder can become symptomatic when a labral tear extends from the biceps anchor into the posterior band of the inferior glenohumeral ligament (PIGHL.) Oftentimes, the progression of this pathology in an inferior direction leads to flattening of the labrum and/or an intrasubstance delamination
Summary
Superior labral pathology is an exceedingly common entity among throwers, and in recent years, a number of reports have elucidated the prevalence of posterior glenohumeral instability among overhead athletes (baseball, softball, volleyball.) within this unique patient population, these conditions should not be viewed as separate clinical entities, but, rather as findings that exist on a single pathomechanic spectrum. Despite the growing body of literature pertaining to posterior glenohumeral instability, there remains a relative paucity of results specific to overhead throwing athletes and even less has been written about the outcomes of posterior labral repairs when performed
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