Shoulder pain in the overhand or throwing athlete. The relationship of anterior instability and rotator cuff impingement.

Shoulder pain in the overhand or throwing athlete can often be traced to the stabilizing mechanisms of the glenohumeral joint. During the physical examination, signs of impingement will often be obvious, whereas subluxation signs are subtle. Use of the Apprehension Test followed by the Relocation Test has proved to be the most sensitive means of detecting occult anterior glenohumeral subluxation. When subluxation is suspected, an examination under anesthesia and orthroscopy are the most helpful next step. Patients can be classified into one of four groups on the basis of the results of the examinations. If conservative rehabilitation fails, then surgery may be considered.