Shoulder Injuries in the Overhead Throwing Athlete

The epidemiology and biomechanics of throwing injuries and unique imaging findings seen in overhead athletes are presented.

Course ID: Q00569 Category:
Modalities: ,


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Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Magnetic Resonance Imaging: 1.25
Image Production: 0.25
Sequence Parameters and Options: 0.25
Procedures: 1.00
Musculoskeletal: 1.00

Radiography: 0.50
Procedures: 0.50
Extremity Procedures: 0.50

Registered Radiologist Assistant: 1.50
Procedures: 1.50
Musculoskeletal and Endocrine Sections: 1.50


  1. Introduction
  2. Epidemiology
  3. Throwing Biomechanics
    1. Phases of Throwing
    2. Achieving Maximum External Rotation
    3. The Total Arc of Motion
  4. Consequences of Adaptive External Rotation
    1. GIRD
    2. Internal Impingement
    3. Rotator Cuff Tears
    4. Labral Tears
  5. Anterior Shoulder Injuries
    1. Anterior Capsule Injury
    2. Subscapularis Tendon Injury
    3. Lesser Tuberosity Injuries
  6. Posterior Shoulder Injuries
    1. Bennett Lesion
    2. Posterior Muscle Injuries
  7. Specific Overuse Injuries
    1. Proximal Humeral Epiphysiolysis (Little League Shoulder
    2. Glenoid Osteochondral Injury
  8. Shoulder Injuries in Overhead Sports Other than Baseball
  9. Technical Considerations
    1. MR Imaging
    2. US and CT
  10. Conclusion


Upon completion of this course, students will:

  1. state the fastest athletic movement performed in sports
  2. recall what sport has been the most widely studied for repetitive overhead activity
  3. cite the number of players in the United States that play recreational baseball
  4. list the number of youth league, high school, collegiate, minor league and major league baseball players
  5. recall the number of activity-related shoulder injuries that occur annually in Little League baseball players
  6. identify the baseball player position most affected by shoulder injuries
  7. name the time frame of the baseball season when most MLB shoulder injuries occur
  8. compare injury statistics of rookie and veteran minor league baseball players
  9. state the number of established phases of throwing in baseball
  10. list in order the throwing phases in baseball
  11. recall the most important phases of throwing which are pertinent to shoulder injuries
  12. describe the body position during maximum external rotation during the arm cocking phase of throwing
  13. explain which muscles achieve maximum activity during the acceleration phase of throwing
  14. state the throwing phase that imparts the greatest glenohumeral joint loading
  15. recall the force during the deceleration phase of throwing
  16. describe the action during the final phase of follow-through
  17. state the ball velocity in elite pitchers
  18. recall the most important determinant of ball velocity
  19. explain osseous adaptions and their relationship to increased external rotation
  20. define humeral retrotorsion
  21. define the total arc of motion
  22. review the cause of most shoulder injuries
  23. define glenohumeral internal rotation deficit
  24. recall what a SLAP tear is
  25. state the most common cause of shoulder pain in throwers
  26. share radiologist interpretation pitfalls as related to internal impingement
  27. match “tear of necessity” to posterosuperior rotator cuff tears
  28. recall the positions where labral tears may occur
  29. list the number of SLAP tears
  30. denote the sensitivity of diagnosing SLAP tears on conventional MR images
  31. describe how patients with anterior capsular tear present clinically
  32. describe how MR can be used to evaluate lesser tuberosity injuries
  33. state the alternate name for a Bennett lesion
  34. list the combined functions of the latissimus dorsi and teres major muscles
  35. state when non-surgically treated posterior shoulder injury patients typically return to pre-injury level of play
  36. know the age range for the presentation of Little League shoulder
  37. list treatments for glenoid osteochondral defects
  38. state percentage of shoulder injuries in tennis causing the athlete to leave the sport
  39. recall the preferred imaging modality for soft tissue shoulder injuries
  40. know what imaging modality is becoming more available at baseball stadiums