Shoulder Injury in the Overhead Athlete (Throwers)

In this episode of HSS Presents, David M. Dines, MD, an attending orthopedic surgeon on the Sports and Shoulder Service at HSS and professor of orthopedic surgery at Weill Cornell Medical College, speaks with HSS colleagues Lawrence V. Gulotta, MD, and Joshua S. Dines, MD, about shoulder injuries in overhead athletes. They examine how injury patterns and treatment demands differ among baseball, tennis, volleyball, swimming, and lacrosse athletes, with a focus on the adaptations and pathologies commonly seen in throwers. The discussion explores internal impingement, microinstability, labral and rotator cuff injuries, eccentric muscle injuries, and the importance of evaluating the entire kinetic chain. The experts emphasize specialized physical therapy, progressive strengthening, and structured throwing programs as the foundation of treatment, while considering the limited and selective roles of injections and surgery. They also discuss evolving surgical strategies that minimize overtightening and set realistic expectations for returning athletes to high-level play.