Shoulder Injuries in the Throwing Athlete
Sports Shoulder Injuries (eg Tennis, Cricket, Baseball, Volleyball)
Shoulder injuries are usually associated with serving or pitching. While this overarm throwing activity can produce great speed and distance for the ball, when performed repeatedly, it can place a lot of stress on the shoulder.
The shoulder is a shallow ball and socket joint, formed by the bone of the upper arm (humerus), which articulates with the shoulder blade in a cavity called the glenoid fossa. The joint relies a great deal on surrounding soft-tissue structures such as tendons, ligaments and muscles (rotator cuff muscles) to maintain smooth motion and stability. The glenoid cavity is surrounded by a raised ridge of cartilage called the labrum that deepens the cavity and a ligamentous structure called the shoulder capsule centres the humerus in the cavity. The biceps muscle, rotator cuff and periscapular muscles all work together to stabilise the shoulder.
While pitching, the arm is thrown outward and backward to generate speed. This action forces the head of the humerus forward, stressing the surrounding ligaments and tendons. These stresses can lead to injuries, causing pain and inflammation. Common injuries include:
- Tears of the labrum
- Tendonitis (inflammation of the tendons) and tears of the rotator cuff
- Tendonitis and tears of the biceps tendon
- Impingement of the rotator cuff tendons between the humeral head and glenoid
- Partial dislocation of the joint (instability)
Pain and instability of the shoulder can result in reduced throwing velocity and accuracy.
Your doctor will assess your shoulder injury by reviewing your pain and the movements that produces it, and performing a thorough physical examination. Imaging studies such as X-rays and MRIs may be ordered.
Most shoulder injuries involve soft tissue structures which can be treated by a period of rest, ice application, medication and physiotherapy to stretch and strengthen the muscles and ligaments, improving and maintaining range of motion. A change in throwing technique may be suggested to reduce stress on the injured shoulder.