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Background: The kinetic chain theory is widely used as a rationale for the inclusion of core stability training in athletes. Core stability (muscle capacity and neuromuscular control) impairments may result in less than optimal performance and abnormal force dissipation to the shoulder complex that could lead to shoulder injuries. However, a paucity of literature exists to support this relationship, and no previous studies have investigated the relationship between isolated core neuromuscular control and shoulder injuries. Additionally, lower extremity postural stability has been associated with athletic function and may also be associated with shoulder injuries. The purpose of this study was to compare biomechanical measures of isolated core neuromuscular control and lower extremity postural stability between athletes with and without non-traumatic shoulder injuries., Methods: Eighty athletes (55 males, age: 21.2 ± 3.3 years, 40 with a current shoulder injury) completed biomechanical measures of isolated core neuromuscular control and lower extremity postural stability. Athletes were matched by age, gender, body mass index, and sport type. MANOVAs were used to assess differences between measures of core neuromuscular control and lower extremity postural stability between groups., Findings: There were no statistically significant differences between athletes with and without shoulder injuries for the static core neuromuscular control measures, F(4,75) = 0.45, P = 0.78, η 2  = 0.02; dynamic core neuromuscular control measures, F(4,75) = 0.81, P = 0.52, η 2  = 0.04; or lower extremity postural stability measures, F(8,61) = 0.85, P = 0.56, η 2  = 0.10., Interpretation: Although core stability is widely incorporated in rehabilitation of athletes with shoulder injuries, athletes with current non-traumatic shoulder injuries may not present with impairments in core neuromuscular control or lower extremity postural stability., (Copyright © 2019. Published by Elsevier Ltd.)

There continues to be a high incidence of shoulder injuries in throwing athletes, with sometimes disappointing return-to-play outcomes, creating an increased need to understand the pathophysiology of the injury and to better characterize the injury during the clinical examination. Current concepts suggest that the disabled throwing shoulder is a useful construct to develop a more comprehensive view of the complex local and distant musculoskeletal alterations that can be seen associated with the clinical symptoms. The pathophysiology can be seen as a cascade to injury, in which proximal or distal deficits in motion, strength, and strength balance can affect force production, joint position, and joint loads throughout the kinetic chain. Local imbalances between force production and load can create anatomic injury or create distant imbalances that create the injury. The evaluation then becomes a more comprehensive one, necessitating a look at all areas of the kinetic chain and evaluation of them in the context of the requirements on the structures during each of the phases of the throwing motion. Specific testing for core stability, scapular stability and motion, and local muscle strength, strength balance, and flexibility needs to be performed, as well as tests for tissue injury.

Little is known about outcomes of glenoid labral repair in Major League Baseball (MLB) pitchers. We hypothesized that following repair, pitching performance would not be significantly different from an uninjured cohort. Fifty-one pitchers were identified who pitched in at least one MLB game prior to undergoing isolated glenoid labral repair. For the three years prior to and following surgery, demographic and performance variables were analyzed for an association with labral injury and repair, and compared to a control cohort of MLB pitchers without history of repair. Following surgery, 72.5% of pitchers returned to MLB at a mean of 13.1 months with no significant change in performance. Starting pitchers had a higher risk of labral injury requiring repair (p< or =0.05). Pitchers that returned to play averaged more innings pitched in the seasons prior to surgery and had a higher body mass index than those that did not return to play (p< or =0.05). Approximately 70% of MLB pitchers undergoing labral repair can be expected to return to competition postoperatively with no significant change in performance. Starting pitchers are more likely to undergo repair, but pitchers with greater preoperative innings pitched per season have a greater likelihood of returning to play., (Copyright Georg Thieme Verlag KG Stuttgart . New York.)

Purpose: The overall purpose of our study was to examine the sensitivity of physical examination, magnetic resonance imaging (MRI), and magnetic resonance (MR) arthrogram for the identification of arthroscopically confirmed SLAP lesions of the shoulder., Methods: An analysis of 51 consecutive patients with arthroscopically confirmed SLAP lesions and no history of shoulder dislocation was performed. Before undergoing surgery, all patients underwent a standardized physical examination and had either an MRI and/or MR arthrogram performed. Sensitivity analysis was then performed on the results of both the physical examination maneuvers and the radiologic imaging compared to the arthroscopic findings at surgery., Results: The sensitivity of O'Brien's (active compression) test was 90%, whereas the Mayo (dynamic) shear was 80% and Jobe's relocation test was 76%. The sensitivity of a physical examination with any 1 of these 3 SLAP provocative tests being positive was 100%. Neer's sign (41%) and Hawkin's impingement tests (31%) each had low sensitivity for SLAP lesions. The sensitivity of MRI for SLAP lesions was 67% when interpreted by the performing surgeon, 53% when read by a radiologist. When the MR arthrograms were analyzed alone, the sensitivity was 72% (surgeon) and 50% (radiologist), respectively., Conclusions: All 3 physical examination maneuvers traditionally considered provocative for SLAP pathology (O'Brien's, Mayo shear, and Jobe's relocation) were sensitive for the diagnosis of SLAP lesions. MRI and MR arthrogram imaging had lower sensitivity than these physical examination tests in diagnosing SLAP lesions. Patient history, demographics, and the surgeon's physical examination should remain central to the diagnosis of SLAP lesions., Level of Evidence: Level II, development of diagnostic criteria on basis of consecutive patients with universally applied gold standard.