Common conditions in the overhead athlete.

The overhead athlete is at unique risk for injury because of the mechanics associated with rapid shoulder elevation, abduction, and external rotation. Angulation of the humeral head against the posterosuperior glenoid can cause rotator cuff tendon and labral impingement. The throwing or striking motion of baseball, softball, water polo, tennis, racquetball, and volleyball may result in scapular dyskinesis, partial articular-sided supraspinatus avulsions, and posterosuperior labral tears. The SICK scapula syndrome (scapular malposition, inferior medial border prominence, coracoid pain and malposition, and dyskinesis of scapular movement) is thought to increase the risk of injury in the overhead athlete. Special physical examination maneuvers and magnetic resonance imaging may be helpful in diagnosing intra-articular pathology. Rehabilitation of injuries associated with internal impingement of the shoulder should include three basic components: strengthening, stretching, and sport-specific exercises. Arthroscopic surgery may be considered if symptoms do not improve after three months of conservative management.