Shoulder Injuries in the Throwing Athlete – OrthoInfo – AAOS
Overhead throwing puts a tremendous amount of strain on the shoulder, particularly on the anatomy that holds the shoulder in its stable position. Because these high pressures are repeated over and over again in throwing athletes, they can result in a wide variety of overuse injuries. Although throwing injuries to the shoulder are most typically observed in baseball pitchers, they can occur in any athlete who engages in sports that demand repetitive overhead motions, such as volleyball, tennis, and several track and field events, as well as in other sports.
Your shoulder is a ball-and-socket joint (clavicle).
The glenoid is the name given to this socket.
The labrum contributes to the deepening of the socket and the stabilization of the shoulder joint.
- The shoulder capsule, a thick band of connective tissue that surrounds the head of the upper arm bone and maintains it oriented in the glenoid socket, serves as the ligament system for the shoulder.
- Your shoulder is also supported by strong tendons and muscles, which help to maintain its stability.
- Rotator cuff syndrome is caused by four muscles that join together as tendons to produce a covering of tissue that surrounds the head of the humerus, which is known as the glenoid.
- The top of the shoulder socket is where the long head is attached (glenoid).
- In addition to the ligaments and rotator cuff, the muscles in the upper back play a vital role in maintaining the stability of the shoulder joint.
- They have control over the scapula and clavicle bones, which together form the shoulder girdle, which serves as the structural basis for the shoulder joint.
The late cocking and follow-through stages of the pitching action exert the most amount of stress on the shoulder among the five phases that make up the pitching motion.
- Phase of late cocking. Throwers must raise their arm and hand over their heads and behind their bodies in order to achieve maximum pitch speed. This arm posture with high external rotation aids the thrower in getting the ball to go faster
- Nevertheless, it presses the head of the humerus forward, putting substantial strain on the ligaments at the front of the shoulder. After some time, the ligaments become more lax, allowing for more external rotation and faster pitching speed, but at the expense of shoulder stability. Phase of implementation and follow-up. As a result of the acceleration, the arm spins fast inside. Follow-through starts once the ball is released, and the ligaments and rotator-cuff muscles at the rear of the shoulder must absorb large loads in order to decelerate the arm and maintain control over its position.
This is the period of late cocking. Throwers must raise their arm and hand over their heads and behind their bodies in order to achieve maximum pitch speed. However, while this arm posture of high external rotation aids the thrower in generating speed on the ball, it also pulls the head of the humerus forward, putting substantial strain on the ligaments at the front of the shoulder. Over time, the ligaments become more lax, resulting in increased external rotation and pitching speed, but decreased shoulder stability as a result.
Follow-through starts once the ball is released, and the ligaments and rotator-cuff muscles at the rear of the shoulder must absorb large pressures in order to decelerate the arm and maintain control over its position in space.
SLAP Tears (Superior Labrum Anterior to Posterior)
A SLAP injury occurs when the top (superior) section of the labrum is torn or ruptured. This is also the location where the long head of the biceps tendon joins to the labrum at the top of the shoulder. It is possible to have a SLAP rupture at both the front (anterior) and the back (posterior) of this attachment site. The most common symptoms include a catching or locking feeling, as well as discomfort when performing particular shoulder motions. It is also typical to have pain deep within the shoulder or with specific arm postures, such as late-cocking.
Bicep Tendinitis and Tendon Tears
Repetitive throwing might inflame and irritate the upper biceps tendon. This is termed biceps tendinitis. Biceps tendinitis is characterized by symptoms such as pain in the front of the shoulder and weakness. Occasionally, the damage to the tendon produced by tendinitis might result in a tear. A ruptured biceps tendon may produce a sudden, acute discomfort in the upper arm. Some people will hear a popping or breaking sounds as the tendon tears.
Rotator Cuff Tendinitis and Tears
When a muscle or tendon is overused, it can become inflamed. The rotator cuff is typically inflamed in throwers, resulting in tendinitis. Early symptoms include discomfort that extends from the front of the shoulder to the side of the arm. Pain may be present when throwing or other activity, and during rest. As the condition advances, discomfort may occur at night, and the athlete may endure a loss of strength and mobility. Rotator cuff rips often begin by fraying. As the injury progresses, the tendon might rip.
The supraspinatus tendon is where the majority of tears occur in throwing athletes.
Between the rotator cuff and the bone on the top of your shoulder lies a lubricating sac known as a bursa, which helps to reduce friction and irritation (acromion).
The bursa permits the rotator cuff tendons to flow smoothly as you rotate your arm. When the rotator cuff tendons are torn or damaged, this bursa can also become inflamed and uncomfortable.
Overhand throws can result in pinched rotator cuff tendons at the rear of the shoulder due to the interaction of the humeral head and the glenoid during the cocking phase of the throw. Internal impingement is the term used to describe this condition, which can result in a partial tearing of the rotator cuff tendon. Internal impingement can also cause injury to the labrum, resulting in a portion of it peeling away from the glenoid bone. Internal impingement may be caused by a combination of looseness in the structures at the front of the joint and tightness in the structures at the rear of the joint.
When the head of the humerus slides out of the shoulder socket, this is referred to as shoulder instability (dislocation). Chronic shoulder instability is defined as a condition in which the shoulder is loose and slips out of position on a regular basis. In throwers, instability develops gradually over time as a result of years of continuous throwing that strains the ligaments and causes increasing laxity in the joint capsule (looseness). Subluxation occurs when the shoulder moves slightly off-center (subluxation) during the throwing action because the rotator cuff structures are unable to maintain control over the laxity.
On rare occasions, the thrower may notice that his or her arm has “gone lifeless.” Many years ago, the phrase “dead arm syndrome” was used to describe a state of instability.
Glenohumeral Internal Rotation Deficit (GIRD)
For the same reasons as previously stated, the severe external rotation necessary to throw at high speeds often causes stretching and loosening of the ligaments near the front of the shoulder. It is a normal and common consequence of this to have tightening of the soft tissues at the rear of the shoulder, which results in loss of internal rotation. Throwers are more susceptible to labral and rotator cuff injuries as a result of this reduction in internal rotation.
Scapular Rotation Dysfunction (SICK Scapula)
Durable and accurate movement and rotation of the scapula above and below the chest wall are critical components of the throwing action. Aside from the clavicle, the scapula (shoulder blade) is connected to just one other bone: the humerus. As a result, the scapula is supported by many muscles in the upper back in order to maintain its proper posture and allow for normal shoulder mobility. If you throw often, you will notice changes in your scapular muscles, which will alter how the scapula is held in place and raise your risk of shoulder injury.
Pain at the front of the shoulder, around the collarbone, is the most prevalent sign of this condition.
Many throwing sportsmen who suffer from SICK scapula experience tightening of the chest muscles in reaction to alterations in the upper back muscles. Lifting heavy weights and performing chest strengthening workouts might exacerbate this issue further.
Medical History and Physical Examination
Discussions regarding your general medical condition, symptoms and when they first appeared, and the kind and frequency of sports involvement are all part of the initial doctor visit’s medical history element, which takes place at the first appointment. During the physical examination, your doctor will examine your shoulder to determine its range of motion, strength, and stability, among other things. In some cases, they may do particular tests on you, such as putting your arm in various positions to simulate your symptoms.
Discussions regarding your general medical condition, symptoms and when they first appeared, and the kind and frequency of sports involvement are all part of the initial doctor visit’s medical history element, which takes place during the first appointment. While performing a physical examination on you, your doctor will examine your shoulder to see how much mobility it has, how strong it is, and how stable it is. If necessary, they may do particular tests on you, such as positioning your arm in various positions to simulate your symptoms.
In many situations, nonsurgical therapy is the first line of defense against a throwing injury to the shoulder. Treatment options may include the following:
- For the majority of throwing injuries, nonsurgical therapy is the preferred method of treatment. The following are examples of treatment options:
In some cases, your doctor may prescribe surgery based on the information you provide during your history, physical examination, and imaging exams, or if nonsurgical therapy does not alleviate your symptoms. The sort of surgery that is performed will be determined by a number of criteria, including your injuries, age, and anatomical structure. Your orthopaedic surgeon will consult with you to choose the most appropriate technique for your specific health needs. Arthroscopy. Fortunately, arthroscopic surgery may be used to treat the vast majority of throwing injuries.
- The images captured by the camera are shown on a television screen, and the surgeon utilizes these images to guide small surgical tools during surgery.
- During an arthroscopy procedure, your doctor can repair damage to soft tissues, such as the labrum, ligaments, or rotator cuff, that have occurred in the shoulder.
- It is possible that a standard open surgical incision (a few millimeters long) will be necessary to treat the damage.
- For a short length of time, you will most likely need to wear a sling to restrict your arm from moving around.
- Your doctor may decide to remove the sling as soon as you are comfortable doing so in order to begin a physical therapy program.
- Gentle shoulder stretches will help to enhance your range of motion and avoid stiffness in your shoulder joint.
- This usually occurs 4 to 6 weeks after the procedure has taken place.
- Your doctor or physical therapist will take you through a rehabilitation regimen that involves a gradual return to throwing if your objective is to resume overhead sports activities.
- In recent years, there has been a greater emphasis placed on avoiding shoulder injuries sustained during throwing.
- By performing adequate stretching and strengthening exercises for the upper back and torso (core), throwers may help to keep their shoulder girdle in excellent working order.
Pitching standards for younger athletes, including pitch count limitations and minimum rest suggestions, have been devised in order to save youngsters from becoming hurt.
The Arm of a Baseball Pitcher: Understanding Shoulder Pain
The rotator cuff is involved in shoulder discomfort, which is particularly prevalent in throwing sports such as baseball. Many medical words relating to the shoulder have been coined, such as rotator cuff tendinitis, rotator cuff tear, and impingement syndrome, which are all connected to the shoulder. The question is, what does this signify for a baseball player. For starters, the good news is that shoulder discomfort, like the majority of other sports-related ailments, is rarely a surgical need.
- Before addressing treatment options for shoulder discomfort, it may be good to have a basic grasp of the anatomy of the shoulder.
- The humerus, clavicle, and scapula are the three bones and two joints that contribute to shoulder function.
- When you look at your shoulder, you’ll see that it’s a ball and socket joint between the humerus and the scapula.
- The shoulder is the most mobile joint in the body, and as a result, it is the most susceptible to injury.
- Over the course of the throwing action, the shoulder muscles and ligaments endure a considerable amount of strain.
- Shoulder impingement, often known as “impingement syndrome,” is a condition in which the shoulder is compressed.
- Following the release of the ball, the remaining energy in the throwing arm must be dispersed back to the big muscles of the body, which will then absorb it.
In addition to the triceps and rotator cuff, the major muscles of the back and trunk also contribute to the deceleration of the arm and shoulder joint.
This is especially true for pitchers who don’t finish their pitches completely and completely.
When a pitcher has poor biomechanics, as previously indicated, excessive stress can be imposed on the soft tissue components of the shoulder, which can result in injury.
On the subject, countless books have been published.
Ensuring that an athlete learns good throwing technique is a worthwhile investment in the health of their arm and should be encouraged.
Most significantly, it is entirely preventable.
It is critical that athletes be permitted to leave a game at the first sign of shoulder discomfort or soreness, even if doing so is counterproductive to the team’s overall aim of winning the game that day.
The release of myofascial adhesions is performed when muscular tissue is affected.
Scar tissue is difficult to work with because it is rigid and fibrous, whereas good muscle is pliable and elastic, similar to a rubber band.
Once the rotator cuff muscles have been relieved of discomfort and the myofascial adhesions have been released, therapeutic activities are required for a full recovery to take place.
Exercises for Stretching and Strengthening – Shoulder rehab must include stretching and strengthening of the rotator cuff in order to be successful and pain-free after the injury.
College and big league pitchers undertake rotator cuff workouts on a daily basis, even when they are not hurt, as you can see in the video above.
For appointments, please contact 425-823-400 or email [email protected] to book an appointment if you are experiencing shoulder discomfort as a result of a sports injury.
Shoulder Pain When Throwing
In order to throw the ball properly, it must travel in a coordinated and stable pattern throughout the whole shoulder joint. A healthy functioning shoulder is required for this action, and it must move in this pattern in order to be successful. Because of this intricacy, even the smallest anomalies can cause shoulder pain and discomfort in certain people. Photograph by Jose Luis Pelaez / Getty Images
The Motion of Throwing
The throwing action may be divided into four separate stages, as follows: The rotator cuff and other shoulder muscles must lead these motions in a sequential manner in order to have successful throwing mechanics. The labrum is responsible for stabilizing the ball in the socket of the shoulder joint. In order to maintain mobility, the shoulder blade rotation must be coordinated with the arm rotation. Abnormalities in any of these processes can result in discomfort and possibly permanent harm to the shoulder’s internal structures.
- The shoulder blade
- The shoulder joint (cartilage and labrum)
- The rotator cuff muscles and tendons
- The nerves that govern the activity of the muscles
- And the rotator cuff muscles and tendons
It is possible to tailor therapy to the specific spot of discomfort after the source of discomfort has been identified. The function of the shoulder blade, which contains the socket of the ball-and-socket shoulder joint, is an important part of shoulder mobility that is sometimes overlooked. To ensure the function of the ball and socket joint, it is necessary for the shoulder blade to be in good condition. Ligaments, muscles, and tendons connect the shoulder blade to the chest wall, allowing it to move freely.
As a result, while dealing with shoulder joint disorders, physical therapists frequently emphasize scapular mobility as a key factor.
The throwing action generates extremely strong torque and acceleration forces, which operate on the shoulder joint as well as the muscles, ligaments, and tendons that surround the joint during the throwing motion. Shoulder-function problems can cause severe discomfort, whether you’re a professional baseball pitcher or simply playing catch with your youngster in the yard. Some of the signs and symptoms of a shoulder issue are as follows:
- The throwing action generates extremely strong torque and acceleration forces, which operate on the shoulder joint as well as the muscles, ligaments, and tendons that surround the joint and help it to function properly. Abnormal shoulder function may be quite painful, whether you’re an elite baseball pitcher or a parent watching your child play catch in the backyard. The following are some of the signs and symptoms of a shoulder issue:
The throwing action generates extremely strong torque and acceleration forces that operate on the shoulder joint as well as the muscles, ligaments, and tendons that surround the joint. Shoulder-function problems can cause severe discomfort, whether you’re a professional baseball pitcher or simply playing catch with your child in the backyard. Among the signs and symptoms of a shoulder issue are:
The majority of persons who suffer the sudden onset of discomfort when throwing will benefit from non-surgical therapy. Resting the joint and lowering inflammation are two of the most important aspects of therapy in the early stages. Treatments may include the following:
- Ice, anti-inflammatory medicines, and cortisone injections are all options.
Once the acute symptoms of inflammation have faded, a therapist can assist you in returning to full shoulder mobility and strength. The most prevalent anomaly is tightness of the posterior shoulder capsule, which results in a loss of normal internal rotation of the shoulder (patients may notice that when they reach behind their back, they are unable to reach as high on the side with the discomfort). Stretching to restore internal rotation or any other lost motion can assist in restoring a more normal throwing motion to the throwing action.
In addition, the periscapular muscles (muscles that connect to the scapula bone) are critical in ensuring that the scapular motions are synchronized with the throwing action during the throwing motion itself.
For example, a middle-aged individual who does not usually throw may have pain after engaging in an exceptional quantity of throwing for leisure sports or while teaching a children’s program, among other things.
In these situations, following a planned shoulder stretching and strengthening program usually invariably relieves the discomfort.
Surgical intervention may be necessary if you do not see progress after three months of treatment or do not feel well enough to return to competitive sports within six months.
A Word From Verywell
The throwing motion is a complicated shoulder movement that necessitates the proper mechanics of interrelated muscles, tendons, ligaments, bones, and joints in order to be successful. If there is a problem with any portion of this complicated relationship, it might result in shoulder dysfunction and, ultimately, shoulder discomfort during throwing. When the mechanics of the throwing action are disrupted, inflammation is frequently the outcome, and pain is a common sign of the condition. The good news is that noninvasive therapies to enhance the mechanics of the shoulder joint are frequently beneficial in alleviating the symptoms of shoulder discomfort during throwing, which is particularly frustrating for athletes.
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- The throwing motion is a complicated shoulder movement that necessitates the appropriate mechanics of interrelated muscles, tendons, ligaments, bones, and joints in order to function properly. Anomalies in any section of this complicated relationship might result in shoulder dysfunction and, as a result, discomfort when throwing the ball. It is common for inflammation to occur when the mechanics of the throwing action are messed up, and soreness is a common side effect. The good news is that noninvasive therapies to enhance the mechanics of the shoulder joint are frequently helpful in alleviating the symptoms of shoulder discomfort when throwing, which is particularly frustrating for athletes. Your comments are much appreciated. You have successfully registered, and we appreciate your assistance. Unfortunate mistake has occurred. Again, thank you for your patience! The information in our articles are supported by only high-quality sources, such as peer-reviewed research, which are used by Verywell Health. To understand more about how we fact-check and maintain our material accurate, dependable, and trustworthy, see our editing process.
- P. Edwards, J. Ebert, B. Joss, G. Bhabra, T. Ackland, and A. Wang. A review of the literature on exercise rehabilitation in the non-operative therapy of rotator cuff injuries. International Journal of Sports Physical Therapy, 2016
- Tonino, P.M., and colleagues Shoulder Disorders of the Complex Type: Evaluation and Treatment Journal of the American Academy of Orthopaedic Surgery, March 2009, 17:125-136.
Baseball-Related Shoulder Injuries
Shoulder Surgery is a procedure that is performed on the shoulders. Injuries sustained while participating in sports Injuries sustained while participating in sports
What You Need to Know
- When it comes to throwing discomfort, the most common causes are irritated rotator cuff tendons, shoulder instability, and/or labral tears. It is difficult to pinpoint the root cause of throwing discomfort in sportsmen and the level of shoulder stability in these individuals. A physical examination of the shoulder should be performed, however an MRI or arthroscopy of the shoulder may also be recommended. There are a variety of therapy options for baseball-related shoulder injuries that vary based on the nature and severity of the disease. These alternatives include non-operative therapies as well as surgical procedures.
What are common symptoms of shoulder problems in throwers?
Shoulder instability, rotator cuff tendons inflammation, and/or labrum tears are all common causes of throwing discomfort. In athletes, it is difficult to pinpoint the source of throwing discomfort as well as whether or not the shoulder is stable enough. The shoulder should be evaluated with a physical examination first, but an MRI or an arthroscopy of the shoulder may also be necessary. There are a variety of therapy options for baseball-related shoulder injuries that vary based on the nature and severity of the disease.
5 Tips for Preventing Sports-Related Injuries
Many sports-related injuries occur as a result of straining our bodies beyond their existing physical capabilities or degree of training. Dr. Andrew Cosgarea, a sports medicine expert, offers these five suggestions to help you prevent getting harmed.
What causes throwing pain?
When the rotator cuff tendons become inflamed, pain after throwing is common. The shoulder is essentially inflamed or irritated after tossing a football. Although there are various opinions regarding what is causing the discomfort, no one knows for certain what is causing it. To begin with, it is possible that the tendons are under excessive strain. This commonly occurs when someone attempts to get into shape in a short amount of time by working out too hard and too quickly. Large increases in stress are not good for the shoulder and rotator cuff tendons, regardless of whether it is early in the season or late in the season.
- For example, cutting back on throwing for a short amount of time, applying ice after throwing or even a few times per day, using anti-inflammatory drugs, and performing rehabilitation exercises are all options.
- If the workouts hurt, you are either performing them incorrectly or your body is trying to communicate with you.
- The amount of time allotted for healing is dependent on a variety of circumstances.
- The most widely accepted explanation is that the discomfort is caused by the shoulder joint being too lax.
- This increases the amount of tension placed on the tendons, causing them to pain.
- Another possibility is that the discomfort is caused by laburoscopy-induced labrum rips.
It can get ripped over time as a result of tension. It is debatable whether labral tears may truly produce symptoms, because it is possible that a labral tear is a signal that the joint is loose but is not the actual reason of the joint being loose.
How do you make a diagnosis?
There are a variety of factors that make determining the source of shoulder discomfort in throwing athletes challenging. The fact of the situation is that it is difficult to determine whether or not the shoulder is loose. It has been demonstrated in studies that the shoulder has a certain amount of mobility that is considered normal; however, it is difficult to determine whether the shoulder is too loose or not during an examination of the shoulder. Despite the fact that some surgeons claim to be able to discern, investigations have revealed that this evaluation is very subjective and is not likely to be very repeatable among examiners.
- The similar issue arises when it comes to the identification of labrum injuries in the shoulder joint.
- However, studies by independent observers have found that these tests are not very accurate in detecting labrum tears in the shoulder.
- Labrum tears do not manifest themselves with a distinct set of signs or pains that distinguish them from tendinitis-related discomfort.
- Although magnetic resonance imaging (MRI) is useful for evaluating the rotator cuff, it is not particularly useful for evaluating the labrum.
- Sometimes the alterations they observe in the labrum or rotator cuff are just age-related changes that do not represent a significant part of the underlying cause of the disease.
When should you have surgery?
The choice to have surgery is taken in the vast majority of situations because nothing else has worked. In the majority of cases, it is impossible to determine whether or not the shoulder is truly unstable prior to surgery. The practice of trying all nonoperative options before undergoing surgery is usually considered to be a desirable approach. Cortisone injections may be useful in some cases, however their usage is debatable. Occasionally. Certainly, a thrower should not be given more than a few of shots because if they are given more than that, they may weaken the tendons in their arms.
- The intensity of the symptoms is the first factor to consider.
- Another consideration is if the player has a long-term career in the sport.
- Another factor to consider is the level of competition, since a second stringer on the fraternity team is unlikely to require a surgery in order to further their career.
- There is a three-month recovery time for all throwing shoulder procedures, regardless of whether they are for tightening the shoulder or for correcting a torn labrum.
Some athletes recover more quickly than others, but pitchers require a lengthier recovery period due to the heavy demands placed on their throwing arm. As a result, these surgeries should not be undertaken carelessly, as the recuperation period is lengthy thereafter.
Which surgical option is best?
Many different viewpoints and possible answers are generated while dealing with complex problems in medicine, as is the case with many other topics in the field. In the case of a shoulder that has failed nonoperative therapy, the standard procedure is to do an arthroscopy to examine the shoulder before proceeding with surgery. General anesthesia is usually used for this procedure, while some surgeons just employ a nerve block to numb the arm to accomplish the same result. The arthroscope is the most effective tool for evaluating the labrum and the rest of the tissues within the shoulder joint and glenoid.
- The findings are often divided into three categories: The first category contains those signs indicating the shoulder is in a state of instability.
- If both of these results are present, the shoulder is unquestionably in unstable condition.
- The options for fixing the instability if these findings are present are as follows: an incision to open the shoulder and repair the damage, an arthroscopic surgery to repair the structures, a combination of arthroscopic procedures with a heating of the capsule to shrink it.
- This is the second scenario: a shoulder with results that are suspected to be associated with instability, but which have not been shown to be associated with instability.
- Generally, these data are interpreted as indication that the shoulder is slipping excessively in these situations.
- This type of repair can only be performed through an arthroscopic procedure.
- Because it is thought that these alterations are the result of shoulder instability, the options for tightening up the shoulder are the same as those listed above.
- This means that no labrum rips, cartilage damage, or rotator cuff issues have ever occurred in this patient.
- The alternatives for tightening are the same as those listed above, but generally, an open capsular shift is performed to get the desired results.
While thermal shrinking has not been studied extensively, some surgeons believe it is as effective as an open procedure in this situation. However, there are no published studies on the subject.
SLAP Tear Prevention Tips for Baseball and Softball Players
A SLAP tear is a dangerous injury that may affect anyone, regardless of their age or professional level. They are not always caused by a single event and are more often caused by repeated stress to the shoulder joint itself. Doctor John Wilckens, a sports medicine specialist, describes how SLAP rips are caused and what athletes, their parents, and coaches can do to avoid suffering from this condition.
What are the results of surgery?
For the most part, most players can regain their prior level of throwing ability, and it takes an average of nine months for the majority of players to be competitive again. The sort of rehabilitation required in the first few weeks following surgery is dependent on the treatment performed; however, by three months, the player should have regained the majority of their range of motion. A light throwing program may be begun in as little as four months, and it will take around three to four months to complete all of the fitness necessary to have the stamina to compete in the sport of throwing.
- An incision is created on the front of the shoulder in the more conventional procedure, which has been documented in the scientific literature.
- In practice, this means that the vast majority of players return to throwing, although even after surgery, some players may decide to retire from the sport, often for reasons unrelated to their arm.
- It will take a lot of effort to recuperate from surgery, but there is a good probability that you will be able to participate again.
- Early findings indicate that the temperature change does, in fact, cause a significant number of players to revert to throwing, but the precise percentage is unknown.
The current approach at Johns Hopkins
Because the vast majority of instances of shoulder tendinitis resolve without the need for surgery, it is critical to do all possible to avoid surgery. In addition, if the shoulder has to be tightened up after surgery, the healing time would be prolonged. In addition to a thorough physical examination of the shoulder, frequent radiographs or X-rays of the shoulder should be taken for diagnostic purposes. If an MRI is performed, we propose an arthrogram, which is a procedure in which dye is injected into the joint before the MRI is performed.
- When deciding whether or not surgery is necessary, it is crucial to evaluate the athlete’s degree of competitiveness as well as where they are in their careers at the time.
- The amount of time required for recovery is also an essential issue, because surgery must be scheduled such that the patient is fully recovered before the season begins at the level of play in which he or she is participating at the time of the surgery.
- After that, we administer a general anesthesia to ensure that the athlete does not recall anything that happened during the procedure.
- If there is further damage that indicates that the shoulder is loose, we propose making an incision and doing an open procedure.
- A thermal capsular shift treatment has been used to treat shoulder injuries when there is not a great deal of damage to the joint at the time of surgery.
- We prefer to utilize this procedure more frequently in athletes such as swimmers or volleyball players who are experiencing discomfort but have not suffered significant joint injury.
Considering and discussing each option with your doctor should be a time-consuming process. In addition, the surgeon’s previous experience with each approach should be taken into consideration, as he or she may be more comfortable with one operation than another.
Common Shoulder Injuries in Throwing Athletes
Your body is subjected to significant physical difficulties whether you are a professional athlete or an amateur athlete, making you more prone to injury. Athletes and active persons of all types benefit from the expertise of our sports medicine team, which provides counseling on injury prevention, as well as effective diagnosis and treatment of injuries. Stress on the shoulder is a major source of concern among throwing athletes. Sporting activities such as baseball, volleyball, tennis, and track & field all need players to do repetitive overhand movements, which puts a strain on their shoulders’ stability.
- At Rebound, our staff has more than 50 years of combined expertise in treating these types of shoulder injuries in college, professional, and amateur athletes of all levels.
- Tendinitis and tears of the rotator cuff Throwing athletes impose enormous demands on their shoulders, particularly on the rotator cuff, in order to achieve peak performance.
- Many athletes may reject the first signs and symptoms since they are often modest, including just minimal discomfort during exercise or resting periods.
- As tendinitis advances, the tendons become worn down and frayed, which is a common complication.
- Internal rotator cuff injuries are the most prevalent type of rotator cuff injury.
- Anxiety or discomfort during physical exertion or when lifting and lowering the arm While resting or lying down on the damaged shoulder, you may experience pain. The inability to carry out everyday tasks, such as combing one’s hair, buttoning one’s shirt, or lifting things, without difficulty or discomfort
- With movement, there is a crackling or grinding feeling.
Injury to the top region of the labrum (the cup-shaped cartilage rim that lines and strengthens the ball and socket joint of the shoulder) is known as a SLAP Tear injury. Due to the fact that it is often caused by repeated shoulder motion, this ailment is widespread among throwing sportsmen. The most common cause of this injury is fast overheard movement; however, it can also develop over time as a result of the labrum being strained, torn, or frayed over time (or naturally through the aging process).
Symptoms of a SLAP Tear
- Shoulder SLAP TearsASLAP Tear is an injury that affects the top part of the labrum, which is the cup-shaped cartilage rim that borders and strengthens the ball and socket joint of the shoulder. Due to the fact that it is often caused by repeated shoulder motion, this ailment is prevalent among throwing sportsmen. The most common cause of this injury is fast overheard movement
- However, it can also develop over time as a result of the labrum being strained, torn, or frayed (or naturally through the aging process). A pitcher’s risk of SLAP tears is higher than the average. Symptoms of SLAP Tear
Tendinitis of the biceps Bicep Tendinitis, also known as inflammation and irritation of the upper biceps tendon, is a condition that develops as a result of repeated throwing and causes discomfort in the front of the shoulder. Athletes may also notice weakness and discomfort in their shoulders. Tears in the Bicep Tendon In the absence of therapy or rest from exercise, bicep tendinitis worsens and causes damage to the tendon, which may eventually result in a tendon tear. When a tear occurs in the upper arm, the athlete will often suffer a quick, intense pain in the upper arm (sometimes accompanied by a popping or snapping sound).
Internal impingement happens during the “cocking” phase of throwing (such as the period in a baseball pitcher’s delivery).
With time, this may result in a partial rotator cuff tendon rupture or damage to the labrum of the shoulder joint.
Shoulder instability occurs when the tissues in the shoulder are unable to maintain the arm’s center of rotation within the socket of the shoulder.
As a result of repeated throwing, the ligaments in the shoulder get stretched, allowing the head of the shoulder to fall more readily from the socket. In turn, the athlete may endure discomfort, numbness, and reduced throwing velocity as a result of the injury.
Shoulder Pain in the Overhead Throwing Athlete
Aftab Al-Farrahma (AF), David Sadler (DS), Peter Stuart (PS), Mohammad Z. Khan (MZ), and John Boland (JP). In the case of spontaneous (effort) axillary-subclavian vein thrombosis, conventional treatment was compared to thrombolytic therapy. 1991; 161:459-4652 in the American Journal of Surgery. Clinical and surgical therapy of symptoms caused by the cervical rib and scalenus anticus muscle, Adson W, et al. Surgical Gynecology and Obstetrics, vol. 85, no. 6, pp. 687-7001, 1947. I. Aiello, G. Serra, G.
David Altchek and Dr.
Shoulder injuries in throwing athletes are common.
Gdumal, R.H., Andrews JR, et al.
565–5716 in the Journal of Clinical Sports Medicine, 1987.
Arko FR, Harris EJ, Zarins CK, Olcott C., IV.
J Vasc Surg 2001; 33:935-9427.
Guskiewicz, and S.G.
The scapular kinematics and muscular strength of the scapula are altered as a result of prolonged overhead throwing.
The American Journal of Sports Medicine published an article in 1990 titled “Am J Sports Med 18:225-2289.” The authors, Burkhart S.S.
In the overhead athlete, SLAP lesions are common.
2001; 32:431-441, viii.
2001; 32:431-441, viii.
The throwing shoulder with a disability: a spectrum of pathologies Pathoanatomy and biomechanics are covered in Part I.
Morgan, and W.B.
Arthroscopy, volume 19, issue 6, page 641-66112, 2003.
8:65-69 (Journal of Hand Surgery, 1983).
Professional baseball players with partial-thickness rotator cuff injuries and SLAP lesions were treated with arthroscopic surgery, according to Conway JE.
The spinoglenoid ligament’s anatomical and histological properties are discussed below.
Journal of Bone and Joint Surgery of the United States of America.
2000; 82:415-42417 in the Journal of Bone and Joint Surgery of the United States.
Imhoff AB, Debski RE, Patel PR, Fu FH, Woo SL.
7:238-24318 (Journal of Shoulder and Elbow Surgery, 1998).
Thrombosis due to exertion in a high-level throwing athlete.
American Journal of Sports Medicine.
CJ Dillman, G.S.
Donatelli R, Ellenbecker TS, Ekedahl SR, Wilkes JS, Kocher K, Adam J In this study, the shoulder strength of professional baseball pitchers was evaluated.
J Orthop Sports Phys Ther 2000; 30:544-55121.
When it comes to professional baseball players, clinical measurements of shoulder mobility are taken.
Drez D., Jr.
In the differential diagnosis of rotator cuff injury, suprascapular neuropathy should be considered.
Effort thrombosis is a consequence of thoracic outlet syndrome that occurs when the patient exerts excessive effort.
Ellenbecker TS, Mattalino AJ, and colleagues Professional baseball pitchers’ internal and exterior rotational strength in the shoulder during concentrated isokinetic motion.
MD Esposito, JA Arrington, MN Blackshear, FR Murtagh, ML Silbiger, MN Blackshear Thoracic outlet syndrome in a throwing athlete was discovered by MRI and magnetic resonance imaging (MRI).
In 1987, the Journal of Bone and Joint Surgery published a 69-page article titled “260-26327.” Escamilla RF, Fleisig GS, Andrews JR, Dillman CJ, and Andrews JR.
Am J Sports Med, 23:233-23928 (July 1995).
Sports Medicine, vol.
Andrews JR, Fleisig GS, Dillman CJ, and Dillman CJ.
The Shoulder of the Athlete Churchill Livingstone, New York, 1994, pp.
Fleisig GS, Escamilla RF, Barrentine SW.
Pitching biomechanics: mechanism and motion analysis are discussed.
In: Baseball injuries are a common occurrence.
A report of 20 occurrences of isolated paralysis of the serratus anterior is presented.
Journal of Bone and Joint Surgery, United Kingdom.
Campbell Quadrilateral space syndrome: diagnostic and decompression procedure in the operating room.
Am J Sports Med, vol.
Gregg, J.R., Labosky, D., Harty, M., and colleagues A young athlete suffers from a paralysis of the serratus anterior.
Grossman MG, Tibone JE, McGarry MH, Schneider DJ, Veneziani S, Lee TQ.
A cadaveric model of the throwing shoulder was used to investigate a probable cause of superior labrum anterior-to-posterior lesions in the throwing shoulder.
Internal impingement of the shoulder: a comparison of results between the throwing and nonthrowing shoulders of collegiate baseball players, Halbrecht JL, Tirman P, Atkin D Arthroscopy, vol.
RY Hinton is a fictional character created by R.Y.
High school baseball pitchers were subjected to an isokinetic examination of their shoulder rotational strength.
Obstacle to flow of blood in the upper extremities.
Surgery, Gynecology, and Obstetrics, 1949; 88:89-12740.
Jackson DL, Farrage J, Hynninen BC, Caborn DN.
5: 134-13641 (Clinical Journal of Sport Medicine, 1995).
The range of posterior superior glenoid impingement has been broadened.
Jobe FW, Giangarra CE, Kvitne RS, Glousman RE, Giangarra CE, Kvitne RS, Glousman RE.
In 1991, the American Journal of Sports Medicine published a 19-page article titled “428-43443.” Jobe FW, Tibone JE, Perry J, Moynes D, Tibone JE, Jobe FW.
Am J Sports Med, vol.
Tullos HS, King J, Brelsford HJ, and Brelsford HJ The pitching arm of a professional baseball pitcher is examined in detail in this study.
The authors are HP Kopell and W A Thompson.
Surgery, Gynecology, and Obstetrics, 1959; 109:92-9647.
Kuhn, JE and Plancher, KD.
1998; 6:267-27348 in Journal of the American Academy of Orthopaedic Surgeons.
Treatment and management of anterior instability in throwing athletes is discussed here.
Thoracic outlet syndrome, according to Leffert RD.
Perlmutter The outcomes of 282 transaxillary first rib resections in the treatment of thoracic outlet syndrome.
Lester B, Jeong GK, Weiland AJ, Wickiewicz TL.
Quadrilateral space syndrome: a review of the diagnosis, pathophysiology, and treatment options.
People who suffer from shoulder impingement may have changes in their shoulder kinematics and accompanying muscle activation, according to research.
2000; 80:276-29153 (in English).
McClure for his assistance.
574-58654, Journal of Orthopaedic Sports Physical Therapy, 1999; 29:574-58654.
Study of a novel therapeutic technique for Paget-Schroetter syndrome, which involves the therapy of spontaneous thrombosis of the axillary-subclavian vein.
Journal of Vascular Surgery Matsen FA finished third, Harryman DT finished second, and Sidles JA finished third.
Clinical Sports Medicine, Volume 10, Number 7, Pages 783-78856, 1991.
The American Journal of Sports Medicine published a 34-page article in 2006 titled 182-18957.
Bigliani Scapulothoracic disorders are a group of disorders affecting the scapula and thorax.
The Shoulder of the Athlete 1994; pp.
New York: Churchill Livingstone; 1994.
Therapy for the treatment of thoracic outlet syndrome.
J Thorac Cardiovasc Surg 1979; 77:169-17460 The biomechanics, pathophysiology, and classification of shoulder injuries in throwing athletes are discussed in detail in Meister K.
Meister, “Injuries to the shoulder in the throwing athlete: part two, assessment and treatment,” Journal of Sports Medicine, vol.
American Journal of Sports Medicine.
Morgan CD, Burkhart SS, Palmeri M, Gillespie M.
Type II SLAP lesions are classified into three categories, each of which has a different association to superior instability and rotator cuff tears.
MYERS, J.B., LAUDENGER, K.G., PASQUALE, M., BRADFORD, J., LEPHART, S.M.
The American Journal of Sports Medicine published a 33-page article in 2005 titled 263-27164.
Baseball pitchers’ internal/external rotation speeds of 180, 300, and 450 degrees per second are depicted in the graph.
Ricci, and S.
Journal of Athletic Training, 43:565-57067 (2008).
Radkowski CA, Chhabra A, Baker CL, 3rd.
The American Journal of Sports Medicine published a 36-page article in 2008 entitled “693-69968.” MJ Rohrer, PA Cardullo, AM Pappas, DA Phillips, and HB Wheeler are among those who have contributed to this work.
Roos, David B.
Am J Sports Med, vol.
Safran) Burns/stingers, thoracic outlet syndrome, and long thoracic nerve damage in athletes are all examples of nerve injuries around the shoulder.
(2002), 36:51-5673, Journal of Vascular Surgery.
Volleyball players that suffer from suprascapular nerve rotator cuff compression syndrome.
The authors (Sheeran, SR, Hallisey, MJ, Murphy TP, Faberman RS, Sherman S) thank the participants for their participation.
Am J Sports Med, vol.
4, 1986, pp.
Sotta, Robert P.
Sports Medicine Clinics of North America, 1990; 9:379-3877.
In 1959, the New England Journal of Medicine published 260:1261-126578.
Toby, ED, and Koman, LA Thoracic outlet compression syndrome is a kind of compression of the thoracic outlet.
: 209-22680; Thorofare (NJ): Slack Publishers, 1989.
Benvenisty for his assistance.
Trakis JE, McHugh MP, Caracciolo PA, Busciacco L, Mullaney M, Nicholas SJ.
Am J Sports Med.
American Journal of Sports Medicine.
Lesions of the throwing arm that are unusual.
Urschel, H.C., Jr., and Razzuk, A.M.
Thoracic Surgery 2000; 69: 1663-166984.
Am J Sports Med.
Am J Sports Med 2002; 30:136-15185.
The neurovascular syndrome caused by excessive arm abduction (hyperabduction).
American Heart Journal, 1945; 29:1-1986. Zarins B, Luallin SR. Zarins B, Luallin SR. Impingement and rotator cuff tears. Andrews JR, Zarins B, and Wilk KE (eds.). In: Baseball injuries are a common occurrence. Lippincott-Raven Publishers, Philadelphia, 1998:87-101