Shoulder
Instability
Glenohumeral dislocation is not difficult to diagnose but athletes are
prone to subtle instability due to stretching of the anterior capsular
structures. Abducting the shoulder and using the arm above shoulder height are
painful. A diagnosis of subacromial impingement is often made because of a
failure to elicit a positive apprehension test. Standing behind the
Treatment
should start with a rehabilitation programme to improve proprioception and
rotator cuff muscle strength. If there is no improvement after 3 months then a
stabilisation is performed by double-breasting the anterior capsule (inferior
capsular shift procedure). Athletes with multidirectional instability due to
ligamentous laxity should be identified and treated nonoperatively as surgery in
these cases is complex and less proven.
Throwing
injuries
Throwing involves a number of distinct phases, each with characteristic
injuries (Table 29.2). Skeletally immature athletes, despite the same
mechanisms of injury, sustain avulsion fractures of the ligament insertions
rather than rupture the ligament.