The shoulder joint sits at the "center of action" for most sports involving the upper extremity. Baseball pitching, tennis, gymnastics, and competitive swimming are sports that share certain similarities (Table 21-2). These overhead endeavors, while all unique, rely heavily on individual accomplishment and intensive, repetitive training. Athletes in these sports may have lengthy careers beginning at a very young age. These sports all require coordinated unrestricted shoulder motion for full participation and success. The capacity for nearly global range of motion is impressive and unique to the shoulder joint. This range of motion allows an athlete to perform the specialized maneuvers necessary to throw a baseball, serve a tennis ball, or swim a race.
As a joint capable of extremes of motion, the shoulder is inherently unstable. Capsuloligamentous structures and muscular stabilizers outweigh bony contact, providing the majority of stability. Dysfunction of these soft-tissue structures, whether through attenuation or imbalance, can lead to instability, impingement, or injury. Healthy, coordinated activity of muscle, ligament, and tendon are all essential to maintain normal pain-free function in the shoulder.
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Since World War II, there has been a tremendous change in the makeup and direction of kid baseball, as it is called. Adults, showing an unprecedented interest in the activity, have initiated and developed programs in thousands of towns across the United States programs that providebr wholesome recreation for millions of youngsters and are often a source of pride and joy to the community in which they exist.