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4th edition authors: W Ben Kibler, George AC Murrell and Babette Pluim


When I dislocated my shoulder back in 2005 and (went through) rehab throughout 2006, I was told by Dr Andrews ‘you’re always going to have to stay on top of that shoulder. You’re always going to have to do a little bit extra to keep it at the level you want to keep it at’. In a lot of ways it was the best thing that ever happened to me because I started doing things that I’d never done before. So I learned so much about my shoulder and how to manage my shoulder.

Drew Brees, NFL quarterback

Shoulder pain and dysfunction are a significant health issue, in the general population as well as in an athletic population. Whilst acute shoulder injuries occur mainly in collision sports or as a result of a sports accident like falling in skiing or biking, athletes performing overhead sports such as tennis, baseball, swimming and gymnastics are also prone to chronic shoulder pain, due to the high demands on their shoulders during their sports performance. In this chapter, the following topics regarding assessment and treatment of shoulder pain are discussed:

  • functional anatomy and biomechanics

  • overview of most common, less common, and not-to-miss causes of shoulder pain

  • clinical examination: from history and basic clinical exam to special tests and outcome scores

  • investigation

  • general treatment and specific rehabilitation guidelines for the most common shoulder injuries in athletes

  • less common causes of shoulder pain: overview of treatment guidelines

  • special considerations for the overhead athlete: the thrower’s program, sport-specific kinetic chain principles and return to play after injury.


The glenohumeral joint is an inherently unstable shallow ball and socket joint, often described as the equivalent of a golf ball (head of humerus) on a tee (glenoid). In fact, the relationship between the humeral head and the glenoid cavity more accurately parallels a sea lion balancing a ball on its nose. Thus, effective shoulder function and stability requires both static constraints—the glenohumeral ligaments, glenoid labrum and capsule—and dynamic constraints, predominantly the rotator cuff and scapular stabilising muscles (Fig. 24.1).

Figure 24.1

Anatomy of the shoulder region (a) Surface anatomy from the front (b) Surface anatomy from behind (c) Rotator cuff musculature from behind (d) Ligaments and muscles around the glenohumeral joint

Static stabilisers

In the neutral position, the coracohumeral ligament and the superior glenohumeral ligament control inferior translation of the humeral head. In an abducted position, all parts of the inferior glenohumeral ligament prevent excessive inferior translation. During external rotation in slight elevation (0–45°), the medial glenohumeral ligament prevents anterior translation. The main static stabilisers of the shoulder ...

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