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Four months ago, a 16-year-old high school multisport athlete (football quarterback/defensive back and baseball shortstop/relief pitcher) was injured in a football game against his team's rival. He sustained a glenohumeral dislocation when a defensive lineman contacted his arm at maximal cocking (90° of abduction and external rotation). He was unable to continue the game and needed reduction of his dislocation in the emergency room. This was his second instability episode. He was diagnosed with a Bankart and Hill-Sachs lesion of his right (dominant) shoulder. Ten days after the dislocation, he had arthroscopic fixation of the Bankart lesion, anterior capsule plication, and remplissage. The patient was referred to physical therapy on postoperative day one (POD 1) by his orthopaedic surgeon. The patient is the starting shortstop and relief pitcher (throws right-handed and is a switch hitter) for the varsity baseball team. The patient hopes to be ready for baseball season; however, his primary goal is to earn the starting role at quarterback for the upcoming football season. The patient is now 4 months postsurgery and able to begin return-to-sport rehabilitation.

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Based on the patient's diagnosis and surgical intervention, what do you anticipate may be the special considerations for the timeframe to return to sport?

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What criteria are critical for progression to the return-to-sport program for baseball?

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What examination techniques could be used to clarify the athlete's readiness for the tasks of the sport?

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What are the most appropriate interventions at this stage of the rehabilitation program?

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What are possible complications that may limit or delay the athlete's return to full participation?

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BANKART LESION: Described as the "essential lesion" of the shoulder by Bankart in 19231; includes an avulsion of the anteroinferior labrum from its glenoid attachment, generally resulting from an anterior shoulder dislocation

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CRITICAL INSTANTS OF FORCE PRODUCTION: The moment during a throwing motion at which peak force is required of the dynamic muscular stabilizers to resist glenohumeral distraction

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HILL-SACHS LESION: Impact fractures of the posterolateral aspect of the humeral head usually caused by anterior dislocation of the glenohumeral joint; this fracture may contribute to recurrent shoulder instability2

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PLICATION: Surgical tightening of soft tissue structures of the shoulder joint; purpose is to reduce the joint volume and looseness to make the joint tighter

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REMPLISSAGE: Surgical technique involving transfer of the posterior capsule and infraspinatus tendon into the Hill-Sachs lesion to prevent engagement of the lesion with the glenoid fossa when the arm is abducted and externally rotated to 90°3

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  1. Identify risk factors for shoulder dislocation related to sport participation and recurrent instability episodes.

  2. Prescribe appropriate interventions to restore the athlete's upper extremity motion, strength, endurance, and joint proprioception by the end of traditional ...

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