As the most mobile joint in the body, the shoulder is prone to both macro- and micro-instability. Throwing a baseball overhead requires a complex synchronization of the anterior and posterior stabilizers of the shoulder. Injuries to the anterior shoulder can be particularly devastating to an overhead athlete because the throwing motion requires significant external rotation and a sudden and powerful transition to internal rotation, to generate force and velocity. Multiple structures in the anterior shoulder are notable when injured in an overhead athlete; these include the subscapularis, the anterior capsule, and the labrum. Injuries can occur on a spectrum, from gradual laxity and microinstability to traumatic laxity and gross instability. This review article review the management of injuries to these commonly injured anterior shoulder structures. Level of Evidence: Expert opinion: Level V.

Overhead athletes rely on proximal-to-distal sequencing to generate, transfer, accelerate, and dissipate force during high-velocity sport actions. Although shoulder and elbow symptoms are often managed locally, the literature supports an integrated kinetic chain framework that views upper-extremity loading and performance as the product of interactions among the lower extremities, lumbopelvic-hip complex, trunk, scapulothoracic articulation, and neuromuscular control systems. The purpose of this narrative review is to discuss integrated kinetic chain function in overhead athletes and to outline practical implications for assessment, rehabilitation, strength and conditioning, workload management, and return to performance. Level of Evidence: Expert opinion level V.

This review article discusses the critical role of nutrition in optimizing recovery for overhead athletes following intense or damaging exercise that induces oxidative stress. The components of recovery nutrition include replenishing glycogen stores, repairing muscle tissue, and rehydrating, while also addressing inflammation, promoting sleep, and matching workload to level of recovery. Detailed information is provided on subjects such as postactivity carbohydrate and fluid requirements, protein synthesis, nutrition that strengthens the immune system, and meal timing that can reset circadian rhythms. Level of Evidence: Expert opinion Level V.

Arthrofibrosis following total knee arthroplasty (TKA) is a challenging complication that contributes to failure to achieve functional range of motion and results in physical impairment, pain, and revision surgery. Despite increasing recognition of arthrofibrosis as a biological disease process rather than a purely mechanical complication, there is no single document that integrates current evidence on diagnosis, surgical management, and preventive strategies. In June 2025, the Stavros Niarchos Foundation Complex Joint Reconstruction Center at Hospital for Special Surgery convened an international symposium to address arthrofibrosis following TKA. Invited experts in orthopedic surgery, basic science, biomechanics, and outcomes research were organized into 3 panels focused on (1) basic science, diagnosis, and risk stratification; (2) surgical management and postoperative rehabilitation; and (3) prevention strategies and adjunctive therapies. Each panel reviewed the literature, addressed predefined clinical questions, and developed consensus through structured discussion. This summary describes the recommendations from each panel, emphasizing early, multispecialty evaluation, stage-specific intervention, and procedure-specific rehabilitation strategies. Gaps in the evidence and priorities for future research are highlighted. These recommendations aim to standardize care, guide clinical decision-making, and shift the focus from late salvage toward early identification and prevention of arthrofibrosis following TKA. Level of Evidence: Level V: expert opinion.

Ulnar collateral ligament (UCL) injuries are common in overhead athletes, and optimal selection of nonoperative versus operative treatment remains variable. This narrative review summarizes contemporary evaluation and management of UCL injuries in overhead athletes, emphasizing how symptoms, athlete goals, chronicity, and tear morphology guide decision-making. Nonoperative care is generally initially utilized for low-grade, proximal partial-thickness tears, and centers on kinetic-chain-based rehabilitation with staged return-to-throwing, with reported return-to-play (RTP) rates near 80%. Adjunctive platelet-rich plasma has gained interest, but available evidence reflects heterogeneous protocols and mixed clinical benefit. Surgery is typically indicated for high-grade, distal, or chronic pathology in high-demand athletes. UCL reconstruction provides reliable RTP rates often exceeding 90% but requires a longer rehabilitation timeline (approximately 12-18 months). Contemporary UCL repair with internal brace augmentation can achieve comparable outcomes with accelerated RTP (approximately 4-7 months) in appropriately selected acute proximal or distal tears with adequate tissue quality. Key gaps include predicting nonoperative failure, standardizing biologic and rehabilitation protocols, defining objective RTP criteria, and strengthening evidence in nonthrowing overhead athletes.

Overhead throwing athletes place unique stresses on the soft tissues of the core and upper extremities, predisposing them to both acute and chronic overuse injuries. In addition to clinical factors and examination, imaging techniques aid in the diagnosis and management of these conditions. Advances in ultrasound and 3D imaging modalities continue to improve detection of these injuries. This narrative review provides an overview of advanced imaging techniques, including recent developments, focusing on the diagnosis of injuries in the overhead athlete.