On today’s episode we’re focusing on the thrower’s shoulder with Dr. Sara Edwards, an orthopedic sports medicine and shoulder surgeon at UCSF. We have some great articles for you that contribute well to our conversation on different shoulder pathology in the overhead throwing athlete.
We start off our discussion today with a review article from the April 2023 issue of the yellow journal titled “Surgical Treatment of Superior Labral / Biceps Pathology in the Overhead Thrower.” The authors concluded that type II SLAP tears are the most common and are often difficult to diagnose due to frequent false positives on MRI. Therefore, history and physical exam correlation are critical. Nonop management – including rest, physical therapy targeting internal rotation deficits, and correction of scapular dyskinesis – can help, but return-to-play rates among pitchers remain low, around ~22%.
When surgery is indicated, options include labral repair, biceps tenodesis, and rarely tenotomy. SLAP repair yields variable outcomes, with elite throwers showing the poorest return to prior performance – often less than 40%. Biceps tenodesis was once a salvage procedure but is now increasingly favored for selected athletes due to higher satisfaction, improved function, and return-to-sport rates of 70–80%. However, its impact on elite throwing mechanics remains uncertain.
Then, from the June 2022 issue of JSES, we discuss a systematic review article titled “Return to play following nonsurgical management of SLAP tears.” This study evaluated outcomes of conservative treatment in 244 athletes (162 of which were elite). Across five studies, the overall return-to-play rate was 54%, rising to 78% among those who completed rehab. Return to prior performance was 43% overall and 72% for rehab completers. Successful programs emphasized restoring internal rotation, correcting scapular dyskinesis, and strengthening the rotator cuff and kinetic chain, with most athletes returning within six months.
Risk factors for failure of conservative treatment were: older age, overhead sports participation (particularly baseball pitchers), traumatic injury, positive compression-rotation tests, rotator cuff pathology, longer careers or symptom duration, and Bennett spurs. Patient-reported outcomes improved significantly with nonoperative care. The authors conclude that nonsurgical management can be effective – especially for athletes who adhere to structured rehabilitation – but success is less predictable in older or high-demand overhead throwers.
We are joined today by Dr. Sara Edwards, an orthopedic sports medicine and shoulder specialist at the University of California in San Francisco, and an Associate Professor at UCSF School of Medicine. She received her medical degree from Northwestern University and remained at Northwestern to complete her orthopedic surgery residency. Thereafter, she completed a fellowship in sports medicine and shoulder surgery at Columbia University. Dr. Edwards is currently the team physician for the City College of San Francisco, the University of San Francisco and the Oakland Ballet.
