Diagnosis and treatment of shoulder injuries in the throwing athlete: the role of thermal-assisted capsular shrinkage.
The treatment of the throwing athlete is complex. Many factors enter into the decision regarding the nature and timing of appropriate intervention. Because of the nature of the mechanical aspects of the throwing motion, increased external rotation (overrotation) is often necessary to throw at a highly competitive level. This increased motion is associated with acquired increased glenohumeral laxity which, by itself, is generally not problematic. However, in the athlete with an overuse-type shoulder injury such as a SLAP lesion or a partial-thickness undersurface tear of the rotator cuff (internal impingement), it is perhaps the increase in glenohumeral laxity that allows such pathology to occur. A careful history and physical examination are important to determine the nature of the injury and the amount of laxity that may be present. Currently, we believe that addressing the capsular laxity arthroscopically at the same time that the intra-articular pathology is addressed is the best form of treatment for these athletes, and affords them the best chance of returning to competition at the same or higher level. Obviously, further follow-up is necessary to determine the long-term results of such treatment.