0:01

Okay, we're ready to, uh, move on with the, uh, rest

0:04

of the program, uh, uh, today.

0:07

And we're going to conclude with one other subject related

0:12

to the shoulder,

0:14

and that is the abnormalities of the shoulder

0:16

that we see in the throwing athlete, uh, in San Diego.

0:21

We do have a professional baseball team, uh,

0:24

the San Diego Padres.

0:26

They've been better of late than they have in the past,

0:30

and, uh, we have encountered, uh, through the years a number

0:33

of problems that seem a bit unique to athletes involved in,

0:38

in throwing sports.

0:40

Now, there are other throwing sports,

0:42

but most of my comments over the next 40 minutes

0:44

or so will relate to the abnormalities you see in the

0:49

baseball pitcher, often professional baseball pitcher.

0:52

And what I would like to do in my organization is at least

0:55

initially present some concepts

0:58

and some of the controversies

1:00

that have developed over the years related

1:03

to these concepts.

1:05

So my general objective is to review the pathogenesis

1:08

and imaging findings of musculoskeletal abnormalities,

1:12

so associated with overhead throwing sports, using baseball

1:16

as our point of reference,

1:18

and emphasizing these basic concepts

1:21

and their current controversies.

1:24

And just to prove you, how years of throwing baseball,

1:27

particularly at a professional level, can lead to damage

1:32

of, of the humeral joint

1:35

and shoulder region is shown on the left, as well as

1:39

to the able, uh, the elbow I present you with these

1:42

pictures derived from a very famous baseball pitcher

1:47

who was in the major leagues for about 20 years.

1:52

And you can see a whole bunch of abnormalities.

1:55

The ones we'll be talking about obviously today will deal

1:58

with the glenohumeral joint.

2:00

Uh, tomorrow when we begin our discussion of the elbow,

2:03

we'll be covering some of the abnormalities

2:05

that occur in the elbow in, uh, overhead, uh, rowers.

2:11

Now, if you go ahead

2:12

and look at the phases of throwing a baseball pitch,

2:16

there are a number of articles that have addressed and,

2:20

and indicated a variety of numbers,

2:23

but most would indicate that there are six stages

2:27

involved in, uh, throwing a baseball.

2:29

And I've listed them there, wind up early cocking,

2:32

late cocking, acceleration, deceleration and follow through.

2:37

And as you'll see, many of the abnormalities

2:40

that I'm gonna emphasize occur in the later phases of, uh,

2:45

throwing a baseball pitcher.

2:46

'cause I think they, those can be the most harmful.

2:49

But just to show you this in a movie format,

2:53

this goes pretty quickly.

2:54

But you'll see the various phases here as I animate this.

3:02

So you can see the sort of energy

3:04

and position of the shoulder that occurs

3:07

during these six phases.

3:10

Now it's my belief based upon my reading,

3:12

that it is the retardation of arm motion

3:16

that requires at the end of the throwing pitch

3:19

to depletion of all energy.

3:21

And, and the way that's accomplished is

3:24

through eccentric contraction of many muscle groups.

3:28

And there's so much energy in throwing a pitch

3:31

that at the very end you have to stop all that energy

3:34

and you have to do that rather suddenly.

3:37

So it's my view in the view of many experts,

3:40

far more experts than I, that the most harmful phase

3:44

of throwing, in fact, is the deceleration of phase.

3:49

Now, keep in mind for throwing a baseball, particularly a,

3:53

a professional level, requires full elevation of the arm.

3:58

And although I'm gonna concentrate on the Glen Al joint

4:01

for a lot of this, uh, discussion, there is actually motion

4:05

that's taking place at four joints around the shoulder.

4:09

Not only the Glen Ural joint,

4:12

but the scapular thoracic acromial, cocurricular

4:16

and sternal cocular joint in general

4:19

during elevation of the arm.

4:20

It's the motion at the glen numeral joint that dominates

4:24

and in fact included here in the initial elevation.

4:28

That motion is about twice the motion

4:30

that occurs at the scapular thoracic joint,

4:33

and later on it becomes about three times that.

4:37

So most of the motion does occur in the region

4:40

of the Glen Al joint.

4:42

Now, when we talk about movements

4:44

that occur at this particular joint, we do so, uh,

4:48

using the axis, the coronal plane of the scapula.

4:52

So here you can see in my diagram the coronal plane

4:55

of the scapula as well as the coronal plane

4:57

of the, of the body.

5:00

And they differ by 30 degrees.

5:03

We'll be talking about the coronal plane

5:05

of the scapula in this lecture.

5:08

And as you look at those movements,

5:10

they take place along three AEs, which I'm showing you here

5:14

as these colored tubes.

5:17

The first of these is the flexion extension shown

5:20

by the yellow tube, and this is along a horizontal

5:24

or medial to later axis.

5:27

The second is the internal

5:29

and external rotation shown by the blue tube,

5:33

and this is occurring along the axis extending from superior

5:37

to inferior, and then abduction

5:40

and abduction shown by the red tube,

5:42

which occurs along an axis in the antral posterior plate.

5:48

Now, there are spectrum of abnormalities

5:50

that can be seen in the throwing shoulder.

5:52

I've listed some of those anatomic structures here. I think

5:56

There are are about eight of those on that list.

5:59

And I've also included on the right a number of buzzwords.

6:02

And as I look at that list, I think

6:05

I'm gonna be including virtually all of them,

6:08

those buzzwords in this particular lecture.

6:11

Uh, we seem to have buzzwords

6:13

for every single topic during this course.

6:16

Uh, I don't think the buzzwords are particularly important

6:19

for some things, but these buzzwords listed on the right

6:23

are po somewhat popular.