Skip to main content

Advertisement

Log in

Pathologies of the shoulder and elbow affecting the overhead throwing athlete

  • Review Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

The overhead-throwing athlete is susceptible to a variety of predictable disease entities affecting the shoulder and elbow. While the pathophysiology and nomenclature of these diseases are ubiquitous throughout the clinical literature, this information is sparse within the radiology domain. We provide a comprehensive review of these unique injuries with accompanying imaging features in an effort to enhance the role of the radiologist during the management of the overhead thrower. When appropriately recognized and described, the imaging features aid in establishing a diagnosis and ultimately the implementation of appropriate clinical management.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15
Fig. 16

Similar content being viewed by others

References

  1. Meister K. Injuries to the shoulder in the throwing athlete. part one: biomechanics/pathophysiology/classification of injury. Am J Sports Med. 2000;28(2):265–75.

    CAS  PubMed  Google Scholar 

  2. Manske RC, Grant-Nierman M, Lucas B. Shoulder posterior internal impingement in the overhead athlete. Int J Sports Phys Ther. 2013;8(2):194–204.

    PubMed  PubMed Central  Google Scholar 

  3. Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology part I: pathoanatomy and biomechanics. Arthroscopy. 2003;19(4):404–20.

    Article  PubMed  Google Scholar 

  4. Wilk KE, Macrina LC, Fleisig GS, et al. Correlation of glenohumeral internal rotation deficit and total rotational motion to shoulder injuries in professional baseball pitchers. Am J Sports Med. 2011;39(2):329–35.

    Article  PubMed  Google Scholar 

  5. Seroyer ST, Nho SJ, Bach Jr BR, Bush-Joseph CA, Nicholson GP, Romeo AA. Shoulder pain in the overhead throwing athlete. Sports Health. 2009;1(2):108–20.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Savoie 3rd FH, O’Brien MJ. Anterior instability in the throwing shoulder. Sports Med Arthrosc. 2014;2(2):117–9.

    Article  Google Scholar 

  7. Laudner K, Meister K, Noel B, Deter T. Anterior glenohumeral laxity is associated with posterior shoulder tightness among professional baseball pitchers. Am J Sports Med. 2012;40(5):1133–7.

    Article  PubMed  Google Scholar 

  8. Roy EA, Cheyne I, Andrews GT, Forster BB. Beyond the cuff: MR imaging of labroligamentous injuries in the athletic shoulder. Radiology. 2016;278(2):316–32. Erratum in: Radiology. 2016;279(1):328.

    Article  PubMed  Google Scholar 

  9. Halbrecht JL, Tirman P, Atkin D. Internal impingement of the shoulder: comparison of findings between the throwing and nonthrowing shoulders of college baseball players. Arthroscopy. 1999;15(3):253–8.

    Article  CAS  PubMed  Google Scholar 

  10. Giaroli EL, Major NM, Higgins LD. MRI of internal impingement of the shoulder. AJR Am J Roentgenol. 2005;185(4):925–9.

    Article  PubMed  Google Scholar 

  11. Mihata T, Gates J, McGarry MH, Neo M, Lee TQ. Effect of posterior shoulder tightness on internal impingement in a cadaveric model of throwing. Knee Surg Sports Traumatol Arthrosc. 2015;23(2):548–54.

    Article  PubMed  Google Scholar 

  12. Walch G, Boileau P, Noel E, Donell ST. Impingement of the deep surface of the supraspinatus tendon on the posterosuperior glenoid rim: an arthroscopic study. J Shoulder Elbow Surg. 1992;1(5):238–45.

    Article  CAS  PubMed  Google Scholar 

  13. Jobe FW, Kvitne RS, Giangarra CE. Shoulder pain in the overhand or throwing athlete. the relationship of anterior instability and rotator cuff impingement. Orthop Rev. 1989;18(9):963–75. Erratum in: Orthop Rev 1989;18(12):1268. Giangarra, CE [added].

    CAS  PubMed  Google Scholar 

  14. Jobe FW, Giangarra CE, Kvitne RS, Glousman RE. Anterior capsulolabral reconstruction of the shoulder in athletes in overhand sports. Am J Sports Med. 1991;19(5):428–34.

    Article  CAS  PubMed  Google Scholar 

  15. Mihata T, McGarry MH, Neo M, Ohue M, Lee TQ. Effect of anterior capsular laxity on horizontal abduction and forceful internal impingement in a cadaveric model of the throwing shoulder. Am J Sports Med. 2015;43(7):1758–63.

    Article  PubMed  Google Scholar 

  16. Grossman MG, Tibone JE, McGarry MH, Schneider DJ, Veneziani S, Lee TQ. A cadaveric model of the throwing shoulder: a possible etiology of superior labrum anterior-to-posterior lesions. J Bone Joint Surg Am. 2005;87(4):824–31.

    PubMed  Google Scholar 

  17. Shah N, Tung GA. Imaging signs of posterior glenohumeral instability. AJR Am J Roentgenol. 2009;192(3):730–5.

    Article  PubMed  Google Scholar 

  18. Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology part III: the SICK scapula, scapular dyskinesis, the kinetic chain, and rehabilitation. Arthroscopy. 2003;19(6):641–61.

    Article  PubMed  Google Scholar 

  19. Mitchell CH, Brushart TM, Ahlawat S, Belzberg AJ, Carrino JA, Fayad LM. MRI of sports-related peripheral nerve injuries. AJR Am J Roentgenol. 2014;203(5):1075–84.

    Article  PubMed  Google Scholar 

  20. Yanny S, Toms AP. MR patterns of denervation around the shoulder. AJR Am J Roentgenol. 2010;195(2):W157–63.

    Article  PubMed  Google Scholar 

  21. Bredella MA, Tirman PF, Fritz RC, Wischer TK, Stork A, Genant HK. Denervation syndromes of the shoulder girdle: MR imaging with electrophysiologic correlation. Skeletal Radiol. 1999;28(10):567–72.

    Article  CAS  PubMed  Google Scholar 

  22. Fabre T, Piton C, Leclouerec G, Gervais-Delion F, Durandeau A. Entrapment of the suprascapular nerve. J Bone Joint Surg (Br). 1999;81(3):414–9.

    Article  CAS  Google Scholar 

  23. Wilson L, Sundaram M, Piraino DW, Ilaslan H, Recht MP. Isolated teres minor atrophy: manifestation of quadrilateral space syndrome or traction injury to the axillary nerve? Orthopedics. 2006;29(5):447–50.

    PubMed  Google Scholar 

  24. Charon JP, Milne W, Sheppard DG, Houston JG. Evaluation of MR angiographic technique in the assessment of thoracic outlet syndrome. Clin Radiol. 2004;59(7):588–95.

    Article  PubMed  Google Scholar 

  25. Qamar SR, Akram MH, Niazi PH. Relationship of length of transverse process of seventh cervical vertebra with positive nerve conduction studies in cases of brachialgia. J Pak Med Assoc. 2011;61(5):429–32.

    PubMed  Google Scholar 

  26. Miller A, Dodson CC, Ilyas AM. Thrower’s fracture of the humerus. Orthop Clin North Am. 2014;45(4):565–9.

    Article  PubMed  Google Scholar 

  27. Seroyer ST, Nho SJ, Bach BR, Bush-Joseph CA, Nicholson GP, Romeo AA. The kinetic chain in overhand pitching: its potential role for performance enhancement and injury prevention. Sports Health. 2010;2(2):135–46.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Pappas AM, Zawacki RM, Sullivan TJ. Biomechanics of baseball pitching. a preliminary report. Am J Sports Med. 1985;13(4):216–22.

    Article  CAS  PubMed  Google Scholar 

  29. Fleisig GS, Andrews JR, Dillman CJ, Escamilla RF. Kinetics of baseball pitching with implications about injury mechanisms. Am J Sports Med. 1995;23(2):233–9.

    Article  CAS  PubMed  Google Scholar 

  30. Lyman S, Fleisig GS, Waterbor JW, et al. Longitudinal study of elbow and shoulder pain in youth baseball pitchers. Med Sci Sports Exerc. 2001;33(11):1803–10.

    Article  CAS  PubMed  Google Scholar 

  31. Guidelines for youth and adolescent pitchers. Http://m.mlb.com/pitchsmart/pitchingguidelines. Accessed Oct 20 2016.

  32. Kancherla VK, Caggiano NM, Matullo KS. Elbow injuries in the throwing athlete. Orthop Clin North Am. 2014;45(4):571–85.

    Article  PubMed  Google Scholar 

  33. Morrey BF, An KN. Articular and ligamentous contributions to the stability of the elbow joint. Am J Sports Med. 1983;11(5):315–9.

    Article  CAS  PubMed  Google Scholar 

  34. Safran MR, Baillargeon D. Soft-tissue stabilizers of the elbow. J Shoulder Elbow Surg. 2005;14(1 Suppl S):179S–85.

    Article  PubMed  Google Scholar 

  35. Callaway GH, Field LD, Deng XH, et al. Biomechanical evaluation of the medial collateral ligament of the elbow. J Bone Joint Surg Am. 1997;79(8):1223–31.

    Article  CAS  PubMed  Google Scholar 

  36. Loftice J, Fleisig GS, Zheng N, Andrews JR. Biomechanics of the elbow in sports. Clin Sports Med. 2004;23(4):519–30. vii-viii.

    Article  PubMed  Google Scholar 

  37. Timmerman LA, Andrews JR. Histology and arthroscopic anatomy of the ulnar collateral ligament of the elbow. Am J Sports Med. 1994;22(5):667–73.

    Article  CAS  PubMed  Google Scholar 

  38. Husarik DB, Saupe N, Pfirrmann CW, Jost B, Hodler J, Zanetti M. Ligaments and plicae of the elbow: normal MR imaging variability in 60 asymptomatic subjects. Radiology. 2010;257(1):185–94.

    Article  PubMed  Google Scholar 

  39. Kooima CL, Anderson K, Craig JV, Teeter DM, van Holsbeeck M. Evidence of subclinical medial collateral ligament injury and posteromedial impingement in professional baseball players. Am J Sports Med. 2004;32(7):1602–6.

    Article  PubMed  Google Scholar 

  40. Del Grande F, Aro M, Farahani SJ, Wilckens J, Cosgarea A, Carrino JA. Three-Tesla MR imaging of the elbow in non-symptomatic professional baseball pitchers. Skeletal Radiol. 2015;44(1):115–23.

    Article  PubMed  Google Scholar 

  41. Munshi M, Pretterklieber ML, Chung CB, et al. Anterior bundle of ulnar collateral ligament: evaluation of anatomic relationships by using MR imaging, MR arthrography, and gross anatomic and histologic analysis. Radiology. 2004;231(3):797–803.

    Article  PubMed  Google Scholar 

  42. Bucknor MD, Stevens KJ, Steinbach LS. Elbow imaging in sport: sports imaging series. Radiology. 2016;279(1):12–28. Erratum in: Radiology. 2016;280(1):328.

    Article  PubMed  Google Scholar 

  43. Timmerman LA, Schwartz ML, Andrews JR. Preoperative evaluation of the ulnar collateral ligament by magnetic resonance imaging and computed tomography arthrography. evaluation in 25 baseball players with surgical confirmation. Am J Sports Med. 1994;22(1):26–31. discussion 32.

    Article  CAS  PubMed  Google Scholar 

  44. Schwartz ML, al-Zahrani S, Morwessel RM, Andrews JR. Ulnar collateral ligament injury in the throwing athlete: evaluation with saline-enhanced MR arthrography. Radiology. 1995;197(1):297–9.

    Article  CAS  PubMed  Google Scholar 

  45. Magee T. Accuracy of 3-T MR arthrography versus conventional 3-T MRI of elbow tendons and ligaments compared with surgery. AJR Am J Roentgenol. 2015;204(1):W70–5.

    Article  PubMed  Google Scholar 

  46. Conway JE, Jobe FW, Glousman RE, Pink M. Medial instability of the elbow in throwing athletes. Treatment by repair or reconstruction of the ulnar collateral ligament. J Bone Joint Surg Am. 1992;74(1):67–83.

    Article  CAS  PubMed  Google Scholar 

  47. Park MC, Ahmad CS. Dynamic contributions of the flexor-pronator mass to elbow valgus stability. J Bone Joint Surg Am. 2004;86-A(10):2268–74.

    Article  PubMed  Google Scholar 

  48. Ciccotti MC, Schwartz MA, Ciccotti MG. Diagnosis and treatment of medial epicondylitis of the elbow. Clin Sports Med. 2004;23(4):693–705. xi.

    Article  PubMed  Google Scholar 

  49. Walz DM, Newman JS, Konin GP, Ross G. Epicondylitis: pathogenesis, imaging, and treatment. Radiographics. 2010;30(1):167–84.

    Article  PubMed  Google Scholar 

  50. Gabel GT, Morrey BF. Operative treatment of medical epicondylitis. influence of concomitant ulnar neuropathy at the elbow. J Bone Joint Surg Am. 1995;77(7):1065–9.

    Article  CAS  PubMed  Google Scholar 

  51. Oshlag BL, Ray TR. Elbow injuries in the young throwing athlete. Curr Sports Med Rep. 2016;15(5):325–9.

    Article  PubMed  Google Scholar 

  52. Lomasney LM, Lim-Dunham JE, Cappello T, Annes J. Imaging of the pediatric athlete: use and overuse. Radiol Clin North Am. 2013;51(2):215–26.

    Article  PubMed  Google Scholar 

  53. Hang DW, Chao CM, Hang YS. A clinical and roentgenographic study of Little League elbow. Am J Sports Med. 2004;32(1):79–84.

    Article  PubMed  Google Scholar 

  54. Paulino FE, Villacis DC, Ahmad CS. Valgus extension overload in baseball players. Am J Orthop (Belle Mead NJ). 2016;45(3):144–51.

    Google Scholar 

  55. Ahmad CS, Park MC, Elattrache NS. Elbow medial ulnar collateral ligament insufficiency alters posteromedial olecranon contact. Am J Sports Med. 2004;32(7):1607–12.

    Article  PubMed  Google Scholar 

  56. Kamineni S, Hirahara H, Pomianowski S, et al. Partial posteromedial olecranon resection: a kinematic study. J Bone Joint Surg Am. 2003;85-A(6):1005–11.

    Article  CAS  PubMed  Google Scholar 

  57. Andrews JR, Timmerman LA. Outcome of elbow surgery in professional baseball players. Am J Sports Med. 1995;23(4):407–13.

    Article  CAS  PubMed  Google Scholar 

  58. Miller CD, Savoie 3rd FH. Valgus extension injuries of the elbow in the throwing athlete. J Am Acad Orthop Surg. 1994;2(5):261–9.

    Article  CAS  PubMed  Google Scholar 

  59. Cohen SB, Valko C, Zoga A, Dodson CC, Ciccotti MG. Posteromedial elbow impingement: magnetic resonance imaging findings in overhead throwing athletes and results of arthroscopic treatment. Arthroscopy. 2011;27(10):1364–70.

    Article  PubMed  Google Scholar 

  60. Furushima K, Itoh Y, Iwabu S, Yamamoto Y, Koga R, Shimizu M. Classification of Olecranon stress fractures in baseball players. Am J Sports Med. 2014;42(6):1343–51.

    Article  PubMed  Google Scholar 

  61. Cain Jr EL, Dugas JR, Wolf RS, Andrews JR. Elbow injuries in throwing athletes: a current concepts review. Am J Sports Med. 2003;31(4):621–35.

    PubMed  Google Scholar 

  62. Schickendantz MS, Ho CP, Koh J. Stress injury of the proximal ulna in professional baseball players. Am J Sports Med. 2002;30(5):737–41.

    PubMed  Google Scholar 

  63. Veillette CJ, Steinmann SP. Olecranon fractures. Orthop Clin North Am. 2008;39(2):229–36. vii.

    Article  PubMed  Google Scholar 

  64. Aoki M, Takasaki H, Muraki T, Uchiyama E, Murakami G, Yamashita T. Strain on the ulnar nerve at the elbow and wrist during throwing motion. J Bone Joint Surg Am. 2005;87(11):2508–14.

    PubMed  Google Scholar 

  65. Posner MA. Compressive ulnar neuropathies at the elbow: I. etiology and diagnosis. J Am Acad Orthop Surg. 1998;6(5):282–8.

    Article  CAS  PubMed  Google Scholar 

  66. Cummins CA, Schneider DS. Peripheral nerve injuries in baseball players. Neurol Clin. 2008;26(1):195–215. x.

    Article  PubMed  Google Scholar 

  67. Britz GW, Haynor DR, Kuntz C, et al. Ulnar nerve entrapment at the elbow: correlation of magnetic resonance imaging, clinical, electrodiagnostic, and intraoperative findings. Neurosurgery. 1996;38(3):458–65. discussion 465.

    CAS  PubMed  Google Scholar 

  68. Bäumer P, Dombert T, Staub F, et al. Ulnar neuropathy at the elbow: MR neurography—nerve T2 signal increase and caliber. Radiology. 2011;260(1):199–206.

    Article  PubMed  Google Scholar 

  69. Keen NN, Chin CT, Engstrom JW, Saloner D, Steinbach LS. Diagnosing ulnar neuropathy at the elbow using magnetic resonance neurography. Skeletal Radiol. 2012;41(4):401–7.

    Article  PubMed  Google Scholar 

  70. Husarik DB, Saupe N, Pfirrmann CW, Jost B, Hodler J, Zanetti M. Elbow nerves: MR findings in 60 asymptomatic subjects—normal anatomy, variants, and pitfalls. Radiology. 2009;252(1):148–56.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sean Wo.

Ethics declarations

Conflict of interest

No funding was provided for this research.

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wo, S., Mulcahy, H., Richardson, M.L. et al. Pathologies of the shoulder and elbow affecting the overhead throwing athlete. Skeletal Radiol 46, 873–888 (2017). https://doi.org/10.1007/s00256-017-2627-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-017-2627-4

Keywords

Navigation