Shoulder Injuries in Handball

Abstract

Shoulder injuries are frequent in handball. They can affect performance and even be career compromising for some players. The shoulder represents between 4 and 27% of all handball injuries. The majority of shoulder injuries in handball are caused by repetitive overhead activities leading to overuse injuries rather than by single traumatic mechanism. There is still controversy about the biomechanics and the underlying pathology of the shoulder injuries. Consistent throwing movements can cause multiple changes involving bony and soft-tissue adaptations resulting in increased glenohumeral external rotation and limited internal rotation, and potentially leading to internal impingement, rotator cuff tears and labral labal tears (posterior and anterior labrum, superior labrum anterior to posterior (SLAP) tears) with scapular dyskinesis. Any weakness or imbalance that alters the components of the kinetic chain, especially in the lower legs and the trunk, can lead to a dysfunctional shoulder and ultimately to a potential risk for upper extremity injuries. A general comprehension of the throwing dynamics and the kinematics of each technique’s phase is crucial for the clinician monitoring these athletes. Players usually complain of pain but can sometimes report unexplained loss of throwing velocity and throwing control. Although laxity findings are relatively common in shoulders of handball players, instability complaints are less frequent, and their significance is yet unclear and controversial. The spectrum of MRI findings in shoulders of handball players includes partial rotator cuff tears and tendinopathy, degeneration and tearing of the posterosuperior glenoid labrum, superolateral humeral head defects cysts and oedema, SLAP lesions and sometimes anteroinferior labrum abnormality. Prudence must be made in the interpretation of these abnormalities, and the therapeutic decision-making, especially surgical, must not rely only on the imaging assessment. Due to the nature of shoulder injuries in handball players, conservative treatment must be primarily considered after an accurate and thorough evaluation of the complaint and symptoms of the patient. A phased progression of rehabilitation has been suggested for the nonoperative management of shoulder injuries in handball players.