Editorial Commentary for In Throwers with Posterior Instability, Rotator Cuff Tears are Common but Do Not Affect Surgical Outcomes

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.