{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T10:46:35Z","timestamp":1790419595152,"version":"4.1.0"},"reference-count":88,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:p>\n                    <jats:list list-type=\"plain\">\n                      <jats:list-item>\n                        <jats:p>\u00bb The thrower\u2019s shoulder has been a subject of great interest for many decades. Different theories have been proposed to clarify the pathophysiology, clinical presentation, and treatment options for this condition. In this review article, we summarize the relevant anatomy and pathophysiology and how these translate into signs, symptoms, and imaging findings. Also, a historical review of the treatment methodologies in the setting of an evolving concept is presented.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>\u00bb The initial event in the cascade is thickening and contracture of the posteroinferior capsule resulting from repetitive tensile forces during the deceleration phase of throwing. This is known as \u201cthe essential lesion\u201d and is clinically perceived as glenohumeral internal rotation deficit (GIRD), and a Bennett lesion may be found on radiographs.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>\u00bb Change in the glenohumeral contact point leads to a series of adaptations that are beneficial for the mechanics of throwing, specifically in achieving the so-called \u201cslot,\u201d which will maximize throwing performance.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>\u00bb The complexity of the throwing shoulder is the result of an interplay of the different elements described in the cascade, as well as other factors such as pectoralis minor tightness and scapular dyskinesis. However, it is still unclear which event is the tipping point that breaks the balance between these adaptations and triggers the shift from an asymptomatic shoulder to a painful disabled joint that can jeopardize the career of a throwing athlete. Consequences are rotator cuff impingement and tear, labral injury, and scapular dyskinesis, which are seen both clinically and radiographically.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>\u00bb A thorough understanding of the pathologic cascade is paramount for professionals who care for throwing athletes. The successful treatment of this condition depends on correct identification of the point in the cascade that is disturbed. The typical injuries described in the throwing shoulder rarely occur in isolation; thus, an overlap of symptoms and clinical findings is common.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>\u00bb The rationale for treatment is based on the pathophysiologic biomechanics and should involve stretching, scapular stabilization, and core and lower-body strengthening, as well as correction of throwing mechanics, integrating the entire kinetic chain. When nonoperative treatment is unsuccessful, surgical options should be tailored for the specific changes within the pathologic cascade that are causing a dysfunctional throwing shoulder.<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list>\n                  <\/jats:p>","DOI":"10.2106\/jbjs.rvw.21.00194","type":"journal-article","created":{"date-parts":[[2022,3,18]],"date-time":"2022-03-18T15:01:10Z","timestamp":1647615670000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":16,"title":["The Thrower\u2019s Shoulder"],"prefix":"10.2106","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2266-9640","authenticated-orcid":false,"given":"Giovanna","family":"Medina","sequence":"first","affiliation":[{"name":"Jefferson Health 3B Orthopaedics, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4079-762X","authenticated-orcid":false,"given":"Arthur R.","family":"Bartolozzi","sequence":"additional","affiliation":[{"name":"Jefferson Health 3B Orthopaedics, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5279-5584","authenticated-orcid":false,"given":"Jacob A.","family":"Spencer","sequence":"additional","affiliation":[{"name":"STAR Orthopedics, Palm Desert, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3053-9958","authenticated-orcid":false,"given":"Craig","family":"Morgan","sequence":"additional","affiliation":[{"name":"Morgan-Kallman Clinic, Wilmington, Delaware"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2022,3]]},"reference":[{"issue":"5","key":"r1-20240731","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1136\/bjsm.2005.023218","article-title":"Shoulder injuries in tennis players","volume":"40","author":"van der Hoeven","year":"2006","journal-title":"Br J Sports Med"},{"issue":"1","key":"r2-20240731","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1177\/0363546516673350","article-title":"Superior Labrum Anterior-Posterior Tears in the National Football League","volume":"45","author":"Chambers","year":"2017","journal-title":"Am J Sports Med"},{"issue":"1","key":"r3-20240731","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/S0033-8389(22)00580-2","article-title":"MR arthrography of the glenohumeral joint","volume":"35","author":"Stoller","year":"1997","journal-title":"Radiol Clin North Am"},{"issue":"3","key":"r4-20240731","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/S0749-8063(05)80105-7","article-title":"The Buford complex\u2014the \u201ccord-like\u201d middle glenohumeral ligament and absent anterosuperior labrum complex: a normal anatomic capsulolabral variant","volume":"10","author":"Williams","year":"1994","journal-title":"Arthroscopy"},{"issue":"6","key":"r5-20240731","doi-asserted-by":"crossref","first-page":"1399","DOI":"10.2106\/00004623-200506000-00031","article-title":"Anterior acromioplasty for the chronic impingement syndrome in the shoulder","volume":"87","author":"Neer","year":"2005","journal-title":"J Bone Joint Surg Am"},{"issue":"3","key":"r6-20240731","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1177\/036354658401200310","article-title":"An EMG analysis of the shoulder in pitching. 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