Biomechanics of the Throwing Shoulder

The throwing shoulder requires a complex coordination of neuromuscular activity. Over time, this extreme repetitive motion results in changes in the shoulder. Some changes are considered adaptive and provide a biomechanical advantage in throwing performance. Other changes are pathologic and require specific injury treatment to return to play. In this chapter, we review the biomechanics of throwing and the complex kinetic chain involved in this task. We will also discuss adaptive changes seen in this population and highlight the pathophysiology seen in throwing injuries. Finally, we will discuss treatment of these injuries with an emphasis on how restoring normal anatomy may compromise the adaptive changes that allowed for a high level of play.