Overuse Injuries on the Upper Extremity

The highly coordinated musculoskeletal sequence in overhead and throwing sports results in multidirectional and supraphysiological stress to the athlete’s shoulder. Therefore, these sports show a high incidence of long-term overload damage. Decentralization of the humeral head leads to a posterosuperior impingement (PSI) and thus to rotator cuff tears as well as lesions of the biceps anchor complex or pulley system. Consideration of joint capsule, scapula, joint stability, rotator cuff muscles and biceps tendon complex is essential for the process of decision-making. Conservative therapy is based on a graded rehabilitation program including training of the complete kinetic chain, joint mobility, strength, endurance and neuromuscular control, especially of the periscapular muscles. Surgical treatment may include SLAP repair, subpectoral biceps tenodesis, reconstruction of rotator cuff tears or posterior capsular release.