Shoulder Injuries in the Overhead Throwing Athlete

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

Outline

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

Objectives

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