Surgical Treatment Trends for Thrower's Shoulder

Recent Approaches and Evolving Surgical Trends in Treating Thrower's Shoulder

In recent years, approaches to treating thrower's shoulder and the trends in surgical management have been undergoing significant changes.
In particular, the American Orthopaedic Society for Sports Medicine (AOSSM) has shifted its recommendations for treating labral tears—one of the most common injuries in thrower's shoulder—away from traditional labral repair and toward biceps tenodesis.
I also emphasize the benefits of biceps tenodesis in cases of biceps tendon injuries, which are part of “shoulder disorders.”
A physician named Franz published in The American Journal of Sports Medicine, stating:

• Biceps tenodesis is effective and particularly recommended for recreational athletes.

In 2023, Dr. Waterman reported in the journal Arthroscopy that:

• Among overhead athletes (such as baseball, volleyball, and American football players), 81% returned to their previous level of competition within an average of 4.1 months after undergoing biceps tenodesis.

The Pathology of Thrower’s Shoulder Is Complex

The underlying conditions that cause thrower’s shoulder—such as partial rotator cuff tears, labral injuries, and shoulder instability—are diverse and complex.
Even in the sports world, it is a well-known fact that the surgical success rate for elbow injuries is higher than that for shoulder injuries, and elbow surgeries are generally more trusted.
This is because previous generations of surgeons have established solid evidence for elbow procedures and ensured reliable return-to-play outcomes for top-level athletes.
As you may know, the successful results of players like Shohei Ohtani of the Los Angeles Dodgers and Hiroto Saiki of the Hanshin Tigers have further strengthened confidence in elbow surgeries.
In contrast, when it comes to shoulder injuries—particularly among pitchers—return-to-play rates tend to be lower, and postoperative performance may decline.
It is also true that some coaches and experienced players advise against shoulder surgery, saying that return to the previous level is unrealistic.
Many athletes with thrower’s shoulder struggle because conservative treatments such as physical therapy or PRP injections fail to bring about satisfying throwing performance.
I am not saying that biceps tenodesis is a universally effective solution for thrower’s shoulder.
However, because reports from the U.S. increasingly support its effectiveness in certain cases, I believe it's important for people in Japan to be aware that this surgical option exists.
 
 

References

１）Biceps Tenodesis for Superior Labrum Anterior-Posterior Tear in the Overhead Athlete: A Systematic Review.Frantz TL, Shacklett AG, Martin AS, Barlow JD, Jones GL, Neviaser AS, Cvetanovich GL.Am J Sports Med. 2021 Feb;49(2):522-528. doi: 10.1177/0363546520921177. Epub 2020 Jun 24.　PMID: 32579853
 
２）High Rate of Return to Sporting Activity Among Overhead Athletes With Subpectoral Biceps Tenodesis for Type II SLAP Tear.Waterman BR, Newgren J, Richardson C, Romeo AA.Arthroscopy. 2023 Jan;39(1):11-16. doi: 10.1016/j.arthro.2022.07.017. Epub 2022 Aug 18. PMID: 35987458