SYMPOSIUM ON SPORTS MEDICINE PART 2 The Shoulder in Sports

Many sports activities that involve the upper extremity entail similar patterns of movement. Analysis of these activities, a better understanding of the throwing motion, and an awareness of shoulder diseases or injuries have led to a rational plan for investigation and management of shoulder problems. Evaluation often extends beyond the usual medical boundaries and must be based on information obtained from an analysis of sports mechanics, a review of training methods, and a physical examination directed at determination of flexibility, strength, endurance, and the presence of inflammation. Three common sports injuries are damage to the acromioclavicular joint (shoulder separation), instability of the glenohumeral joint, and a spectrum of pathologic changes in the rotator cuff. Sports that are commonly associated with shoulder problems include swimming, baseball, tennis, football, and gymnastics. Treatment may comprise rest, changes in training methods, an alteration of technique, and a physical rehabilitation program. Surgical treatment has a well-defined role, but it is usually optional. Most injuries to the shoulder that occur during sports events can also occur during nonsports activities; how­ ever, the techniques and activities of certain sports tend to create a typical pattern of injuries. Some sports actually involve injuries that are unique to them, such as stress fractures of the coracoid process in trapshooters or tears of the glenoid labrum (without shoulder instability) in high-level pitchers. New areas concerning the shoulder are being investigated, especially the throwing mecha­ nism. These studies and an analysis of injury patterns have led to changes in training methods and in re­ habilitation and counseling after injury. Social and eco­ nomic issues can sometimes obscure the physical illness. The health professional must consider these issues but not be overcome by them when establishing an accurate diagnosis, efficient treatment, and guidelines for return to competition. This report outlines the new areas of investigation, delineates developments in the diagnosis and treatment of the three most common injuries to the shoulder, ana­ lyzes the problems that occur in the shoulder in certain major sports, and outlines the current rehabilitation concepts.