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.
When one component, like as the ligament system, gets weaker as a result of repeated stressors, other structures must step in to take on the additional strain. As a result, the throwing athlete is susceptible to a wide range of shoulder ailments as a result of this. The rotator cuff and labrum are the shoulder components that are most susceptible to injury when throwing a ball.
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
SLAP injuries occur when the upper (superior) portion of the labrum is torn. The long head of the biceps tendon joins to the labrum at this place near the top of the shoulder. There are two locations where this attachment point might be torn: the front (anterior) and the back (posterior). The most common symptoms include a catching or locking feeling, as well as discomfort when performing particular shoulder movements, according to the American Chiropractic Association. A typical occurrence is pain deep within the shoulder or with specific arm postures, such as late-cocking.
Rotator Cuff Tendinitis and Tears
It is possible for a muscle or tendon to become inflamed when it has been overused. Throwers typically have irritation of the rotator cuff, which results in tendinitis. Pain radiating from the front of the shoulder to the side of the arm is one of the first signs of the condition. Pain may be experienced when throwing or participating in other activities, as well as during rest. As the condition advances, the athlete may begin to endure nighttime discomfort as well as a loss of strength and range of movement.
- As the deterioration progresses, the tendon may begin to rupture.
- 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).
- When the rotator cuff tendons are torn or damaged, this bursa can become inflamed and uncomfortable as a result of the injury or damage.
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.
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. The findings of these tests assist the clinician in determining whether or not more testing or imaging of the shoulder is required.
Your doctor may request tests to confirm your diagnosis and rule out any underlying issues that may be present. X-rays. Due to the fact that X-rays provide clear images of dense materials such as bone, they will be able to detect any issues inside the bones of your shoulder, such as arthritis or fractures. Magnetic resonance imaging (MRI) is a type of imaging that uses radio waves to create a magnetic field (MRI). An MRI provides more accurate pictures of soft tissues than an X-ray does. It may aid your doctor in the identification of damage to the labrum, ligaments, and tendons that surround your shoulder joint, among other things.
A CT scan is a type of imaging procedure that combines X-rays with computer technology to provide a highly detailed image of the bones in the shoulder region.
Real-time pictures of muscles, tendons, ligaments, joints, and soft tissues may be obtained using ultrasound technology.
Throwing injuries to the shoulder, if left untreated, can develop into more severe disorders.
In many situations, nonsurgical therapy is the first line of defense against a throwing injury to the shoulder. Treatment options may include the following:
- Modification of one’s activity. In the beginning, your doctor may prescribe just altering your daily routine and avoiding things that aggravate your symptoms
- For example, ice. In order to minimize any swelling, ice packs should be applied to the shoulder. Nonsteroidal anti-inflammatory medications (NSAIDs) (NSAIDs). Pain and inflammation can be relieved using anti-inflammatory medications such as aspirin, ibuprofen, and naproxen. Alternatively, they can be obtained without a prescription or purchased over-the-counter. Physical therapy is a type of treatment that involves the movement of the body. Your doctor may prescribe particular exercises to help you increase the range of motion in your shoulder and strengthen the muscles that support the joint, according to your needs. Physical therapy can be used to target muscle and ligament stiffness in the rear of the shoulder and to assist strengthen the structures in the front of the shoulder, according to the American Physical Therapy Association. If you have a damaged structure, such as the labrum or rotator cuff tendon, this can help ease some of the load on it. Position has been switched. Body posture that places an excessive amount of stress on damaged shoulder components might be assessed in order to improve throwing mechanics. A change in posture or even a change in sport might alleviate recurrent strains on the shoulder and give long-term comfort, although it’s not always desired, especially in high-level players
- Cortisone shot If rest, drugs, and physical therapy are ineffective in relieving your pain, an injection of a local anesthetic and a cortisone preparation may be administered to you. Cortisone is a powerful anti-inflammatory medication that has been used for centuries. Injecting it into the bursa beneath the acromion can give pain relief for tears or other structural damage
- However, this is not recommended.
In some cases, your doctor may recommend surgery based on the information you provide during your history, physical examination, and imaging studies, or if nonsurgical treatment 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 traditional open surgical incision (a few centimeters long) will be required to treat the injury.
- For a short period of time, you will most likely need to wear a sling to keep 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 improve your range of motion and prevent stiffness in your shoulder joint.
- This usually occurs 4 to 6 weeks after the surgery has taken place.
- Your doctor or physical therapist will direct you through a therapy program that includes a gradual return to throwing if your goal is to resume overhead sports activities.
- In recent years, there has been a greater emphasis placed on preventing shoulder injuries sustained while throwing.
- By performing proper stretches and strengthening exercises for the upper back and torso (core), throwers can help to keep their shoulder girdle in good working order.
Pitching guidelines for younger athletes, including pitch count limits and required rest recommendations, have been developed in order to keep children from getting hurt.
Treating Arm and Shoulder Injuries in Throwing Athletes
The temperatures are increasing in the spring, which means it’s time to get your body ready for the next baseball and softball seasons. “Above athletes,” or individuals who utilize their shoulder and upper arm to push items overhead, are at risk of developing arm injuries, according to Michael Woodward, PT, DPT, facility director at theUPMC Centers for Rehab Services’ Chicoralocation. He offers a few warm-up activities to help minimize tiredness and muscular tightness during the workout. A considerable percentage of arm injuries related with overhead athletes have been witnessed by Michael in his roles as a physical therapist and baseball coach, according to him.
Although there may be a significant variation in size and velocity [the rate at which players drive the ball] between those players, arm injuries remain the same and can be caused by the same limitations or inadequacies.”
Baseball and Softball Shoulder Injuries
According to Michael, the fundamental purpose of the labrum and rotator cuff is to protect and support the shoulder joint, which is a job that both of these structures do. Alabral tears are associated with instability and greater mobility of the shoulder inside the joint in many cases. An imbalance in muscle strength and movement is frequently evident when there is a rotator cuff injury, which results in weakness and aberrant motions.”
The labrum is a ring of cartilage that surrounds the shoulder joint and offers stability and protection. It also serves as the site of attachment for the long head of the biceps. A tear may be produced by any of the following: In overhead athletes, the most prevalent type of tear is referred as as aSLAP tear, which is an abbreviation for “superior labral tear from anterior to posterior.” This may also include the area where the biceps join to the forearm.
Rotator cuff tear
A rotator cuff tear is another type of shoulder injury that occurs often. Some people believe that the rotator cuff is a single muscle, although it is really composed of four muscles:
- Teres minor
- Supraspinatus (the most often torn)
These muscles help to stabilize the shoulder joint while also allowing the shoulder to rotate. Like labral tears, rotator cuff tears are often induced by traumatic accidents or overuse as a result of throwing or repetitive overhead exercises like as squatting or lifting.
Treatment for Shoulder Injuries
For labral and rotator cuff injuries, there are a variety of successful treatment techniques available.
Global strengthening program
The use of a global strengthening program, such as the “thrower’s ten,” can be an useful therapy option for improving shoulder stability and strengthening the other muscles in order to remove problematic motions. The same shoulder strengthening regimen may be utilized to prevent shoulder injuries in athletes and the general public as well as in the workplace. It will do the following by strengthening the rotator cuff and surrounding muscles:
- Increase your stability and strength
- Reduce your risks of becoming injured from overuse
Thrower’s Ten program
It is called theThrower’s Ten program and it is highly recommended by many top sports medicine specialists and physical therapists. It is a successful program for both pre and post-injury recovery. It consists of a series of ten strength training and stretching exercises that are intended to improve the body mechanics and physiology of throwing athletes while also strengthening and stretching them. It is important to combine rotator cuff development with overhead training in order to simulate a good throwing pattern.
When it comes to developing rotator cuff strength in young athletes, this regimen is very beneficial. It is also beneficial for preseason training, as it prepares the shoulder muscles to be ready for the forthcoming season.
If non-surgical therapies fail to relieve labral and rotator cuff injuries, surgical intervention might be used to correct the problem. If you are a baseball or softball player, coach, or parent of a child who plays baseball or softball, Michael highly advises that you consult with a physical therapist about a pre-season conditioning program. “By learning to do the proper workouts, you will experience less tiredness and muscle pain than you would have otherwise experienced, and you will also see an improvement in your performance velocity.” UPMC Centers for Rehab Services, which assists a wide range of recreational, amateur, and professional athletes in returning to their sport, may provide further information about sports rehab.
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 target treatment to the specific site of discomfort once 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 proper 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, when dealing with shoulder joint problems, 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:
- Aching discomfort: This ache is usually deep in the shoulder or extends down the upper arm
- “Dead Arm” refers to a lack of power in the throwing action. Night Pain: While the pain isn’t too intense when throwing, it might cause you to wake up from your sleep.
When you see your doctor regarding shoulder pain when throwing, the doctor will need to know exactly where the anomaly is in the throwing action in order to treat you. It is vital to locate a healthcare physician that is knowledgeable with the mechanics of throwing. Shoulder pain tests are useful in diagnosing the condition, but only when they are used in conjunction with the symptoms you are experiencing. An MRI may reveal anomalies in the shoulder joints of young athletes and weekend warriors, although they may or may not be the reason of the shoulder pain in these individuals.
The expertise of an experienced examiner who is knowledgeable with shoulder injuries can assist in determining whether or not there is a structural anomaly that has to be corrected.
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.
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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Verywell Health relies on only high-quality sources, such as peer-reviewed research, to substantiate the information contained in its articles. Read about oureditorial process to discover more about how we fact-check our information and ensure that it is accurate, dependable, and trustworthy.
- A resource for orthopaedic information from the American Academy of Orthopaedic Surgeons. Shoulder Injuries in Throwing Athletes are a common occurrence. OrthoInfo is provided by the American Academy of Orthopaedic Surgeons and was last revised in March 2013. Shoulder Impingement/Tendinitis of the Rotator Cuff. The most recent evaluation was conducted in February 2011.
- 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.
How to Treat Shoulder Pain in a Pitcher
In baseball and softball pitchers, who rely heavily on their shoulder muscles to propel the ball over the plate, shoulder soreness is a pretty typical occurrence. These muscles might get inflamed as a result of the intense and repeated activity, resulting in pain and inconvenience. It is possible that young pitchers who have weak and immature muscles may be more susceptible to discomfort as a result of instability in the shoulders. There are, however, a number of solutions that may be used to relieve current pain and prevent future flare-ups from occurring.
- Apply ice packs to the afflicted region three to four times a day for 20 minutes at a time for three to four days.
- Pain relievers such as ibuprofen and naproxen can be used to alleviate edema and inflammation while also helping to decrease swelling.
- Shoulder soreness is more common in players who pitch year-round as compared to those who have recuperation intervals throughout the year, according to research.
- Young pitchers’ muscles and bones are still in the process of developing, and overusing the shoulder muscles can result in pain and injury to these tissues and ligaments.
- Because these exercises are considered passive and soothing, they are ideal for people who have just recovered from a shoulder injury.
- Dropping your shoulder blade and relaxing your muscles will allow you to slowly swing your arm forwards and backwards.
- Holding the back of a chair with your undamaged arm is a good exercise.
Swing your arm in tiny circles, allowing your body motion to serve as the catalyst for the movement.
Images courtesy of Stockbyte/Stockbyte/Getty Images Muscle building and development are important for building and developing stronger shoulder muscles, which will promote shoulder stability and lower your risk of injury.
Don’t push yourself too hard or you’ll end up aggravating the issue even more.
Increase the difficulty by using plyo pushups, which will provide an even bigger workout for your shoulders.
In order to land with your hands shoulder-width apart, you must push up explosively and completely extend your arms.
Standing up and holding the band a few feet away from you, begin your workout. To do this, extend your arms to hold the band until it is nearly taut, then pull your hands closer to your face while thrusting your elbows out to the sides and drawing your shoulder blades together.
If the discomfort intensifies or last for longer than seven days, you should consult a medical professional.
Baseball players frequently damage their shoulders first, before injuring any other body part. In comparison to other joints in the body, the shoulder is a mobile joint with a greater range of motion. With this increased range of motion, the shoulder is more susceptible to injury. The physics of throwing results in significant levels of torque and pressure being applied to the joint. In most cases, an injury occurs when the shoulder is overworked, inflamed, or not strong enough to endure the tension created by throwing the ball properly.
Course of Action for a Hurt Shoulder
Sometimes baseball players will have a shoulder injury before they get an injury to another area of their bodies. In comparison to other joints in the body, the shoulder is a mobile joint with a wide range of movement. The shoulder might easily become damaged due to the increased range of motion. The mechanics of throwing causes large levels of torque and pressure to be applied to the joint during the throwing motion itself. A shoulder injury is common when the shoulder is overworked, inflamed, or not strong enough to handle the torque generated by throwing.
Just Shoulder Tightness
In the event that you determine that your arm is solely suffering because of tightness and inflammation, there are a variety of options available to you. The most effective technique to relieve shoulder discomfort is to enhance blood flow to the region and to stretch it a little. When a baseball player does rotator cuff strengthening exercises using 5 pound dumbbells and moves through a series of exercises, he or she can enhance blood flow to the injured area, promote healing, and reduce inflammation.
- Exercising the shoulder joint is another method of alleviating shoulder discomfort.
- This stiffness in the shoulder is a typical reaction of the body to protect itself against damage.
- It is typical for the arm to get tight after being overused by the body.
- Externally, there is generally little restriction in range of motion, but overuse creates tightness in the internal rotational movement.
- This action has the potential to cause catastrophic damage, therefore it is critical to relieve shoulder stiffness and return to your normal range of motion as soon as possible.
- When you’re lying on your shoulder, raise your elbow so that it’s perpendicular to the rest of your body.
- Internally rotate your throwing hand side by placing your opposing hand on top of your throwing hand side.
If you allow your shoulder blades to drop off your spine, the stretch will transfer from your shoulder to your scapula, which is not where you want it to be stretched at all. Please refer to our shoulder stretch video for a more in-depth explanation and visual reference.
Shoulder Pain | Should I Lift
A common reason for baseball players to avoid lifting weights when their shoulder aches is because of the discomfort it causes. In general, if a baseball player is going to lift huge weights and blast through the entire range of motion, this is a good notion to consider. Lifting weights, on the other hand, is one of the most effective strategies to enhance blood flow and promote recovery. When dealing with a hurting shoulder, it is critical to warm up properly before performing any heavy lifting.
When you have a hurting shoulder, the last thing you want to do is explode the weight.
Don’t overdo it with the weight, and don’t move it too quickly either.
Blood is responsible for the body’s rapid healing and for the circulation of lactic acid out of the shoulder.
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.
Little League Shoulder
Little league shoulder is an overuse condition that affects the arm bone (humerus) closest to the shoulder as a result of repeated stress. Swelling and discomfort in the shoulder are caused by the enlargement of the growth plate, which is caused by the tension. Overhand pitchers between the ages of 11 and 16 are the most susceptible, with the majority of cases occurring in childhood. Injury is a result of a combination of causes, which include:
- Muscle weakness, particularly in the shoulder and upper back
- Lack of coordination
If left untreated, the disease might deteriorate and result in bone injury. There is a very minimal likelihood of the growth plate closing completely. Little league shoulder is sometimes mistaken for a stress fracture or a pediatric fracture known as a Salter Harris Type 1 fracture, which are both quite common in children. The good news is that with rest and a focused therapy program, minor league shoulder may frequently be totally healed.
How Do I Know If My Child Has Little League Shoulder?
Among the signs and symptoms of minor league shoulder are:
- Pain in the shoulder while the arm is at rest or when lifting the arm
How Is It Diagnosed?
A doctor will do a thorough physical examination and may refer you for imaging testing. X-ray imaging, which is performed while your child is in the clinic, may typically be used to determine whether or not your child has little league shoulder and how serious it is. An MRI may be beneficial in some situations. Diagnostic tests are classified into the following categories:
- Shoulder X-rays are the most common type of test for a shoulder injury. When this test is performed, it might reveal a wider or uneven growth plate.
- Magnetic resonance imaging (MRI): MRI delivers a more detailed view of both soft tissues and bone than other imaging techniques. It has the ability to view tendons and ligaments that are not visible with traditional X-rays. It also gives further information about the growth plate.
How Do I Treat Little League Shoulder?
Once your doctor has determined that you have little league shoulder, he or she will choose the best course of therapy. Management that is conservative:
- Rest – your doctor may advise you to refrain from participating in throwing activities for a period of time.
- Reduce swelling, bleeding, and discomfort in the shoulder by applying ice to the area.
- Treatment with physical therapy – Your kid will go through a strengthening and stretching routine with a licensed physical therapist, with the goal of improving the strength of the shoulder and arm muscles. In order to improve general stability and throwing ability, the core, legs, and hips are stressed in the training program.
- Two-dimensional video analysis of throwing motion — At Cincinnati Children’s, we have the capability of doing two-dimensional video analysis of throwing motion. Therapy professionals are trained to break down the processes of throwing in order to identify flaws.
- Two-dimensional video analysis of throwing motion — At Cincinnati Children’s, we have the capability of doing two-dimensional video analysis of throwing movement. In order to identify any faults, trained therapists must break down the processes of throwing.
Injury cannot be totally avoided, but appropriate mechanics, rest, and strength can help to lessen the likelihood of suffering one. A set of rules for young pitchers has been created in collaboration with Major League Baseball (MLB), with the goal of reducing the likelihood of injury. Recommended pitch counts by age, as well as the accompanying rest times are as follows:
|Age||Daily Max (Pitches in Game)||0 Days Rest||1 Days Rest||2 Days Rest||3 Days Rest||4 Days Rest||5 Days Rest|
The following image is courtesy of Pitch Smart. Parents should be alert to any reports of discomfort, exhaustion, or changes in throwing movements that their children may make. These are frequently warning indicators that, if ignored, can result in a more serious injury and even death.
Web pages for more information:
Pitch Smart |MLB.com – Major League Baseball www.littleleague.org
How to diagnose shoulder injuries in young athletes
This is the situation One of your trip baseball players, a 12-year-old right-handed dominant guy, appears to your clinic with complaints of right shoulder soreness. He is a pitcher who also has the ability to play the catcher position. “His shoulder joint” is the source of his discomfort, which has been present for three weeks. He does not have any neck or elbow pain. Neither trauma nor shoulder dislocation or instability are mentioned in the patient’s medical history. As a result of the discomfort, the athlete claims that he is unable to throw as hard or with as much accuracy as he was able to before the pain began, and that no single throw type worsens his condition.
- He also has terrible posture, with shoulders that are slouched to the forward.
- This is the diagnosis (Figure 1).
- During a poll of youth baseball players, just 26% stated that they did not experience arm soreness while throwing the ball at the plate.
- A typical presenting complaint in young athletes, particularly those that engage in repetitive overhead arm movement, is shoulder discomfort.
Football, hockey, wrestling, and winter sports such as skiing and snowboarding are examples of sports in which upper body motion is not as repetitive but there is a significant danger of falls and direct impacts to the shoulder, as well as other sports in which the upper body motion is not as repeated.
- It is, on the other hand, a relatively unstable asset.
- The labrum is a fibrocartilaginous cup that aids in deepening the socket of the shoulder joint, which in turn serves to promote shoulder joint stability.
- Dynamic stabilizers are muscles that allow for mobility while simultaneously aiding in the stabilization of the joint during movement.
- To aid in the movement and function of the rotator cuff, strong scapular stabilizers are necessary (Figures 2A and 2B).
- Pain that occurs suddenly might be caused by a clavicle fracture, an acromioclavicular joint sprain, a dislocated or subluxated shoulder (glenohumeral joint), a labral tear, a proximal humeral fracture, or a contusion.
- In contrast, the gradual start of discomfort in a young athlete is often caused by overuse injury caused by repetitive force applied to a tendon, bone, growth plate, or fascia during training.
- A tumor is also a possibility, and the pain associated with a tumor may be slow in development or severe in nature, such as in the case of a pathological fracture.
Osteosarcoma is the most frequent malignant bone tumor in teenagers, followed by Ewing sarcoma as the second most prevalent.
The differential diagnosis for shoulder discomfort in a juvenile athlete is outlined in the following table.
The patient has a classic history, physical exam, and radiographic findings of Little League shoulder (proximal humeral epiphysiolysis).
Little League shoulder may also be referred to as proximal humeral epiphysiolysis, epiphysitis, or Salter-Harris type 1 damage to the proximal humeral physis, depending on the location of the lesion.
The damage is caused by repetitive overhead rotational tension.
Athletes who suffer from Little League shoulder will describe a gradual development of pain when throwing or performing overhead activities.
It is clinically determined when a young athlete has discomfort on examination over the proximal humeral growth plate and is treated accordingly.
Because overhead-throwing athletes are more likely than the general population to suffer from rotator cuff tendinopathy, biceps tendinopathy, or shoulder impingement, these diagnoses would be taken into account in this patient.
In the absence of previous shoulder dislocation or subluxation occurrences, a diagnosis of shoulder instability is less likely to be made in this case.
Athletes who experience shoulder pain may have an underlying ailment that predisposes them to developing the condition.
The absence of an osseous mass on imaging or an acute fracture in this instance rules out the presence of any other entities in our differential diagnosis in this case.
Acute trauma, such as clavicular fractures or sternoclavicular or acromioclavicular dislocations, can result in visible deformity, edema, and ecchymosis.
Inspecting the patient’s posture is important since it may be bad, with forward-slumped shoulders that might contribute to discomfort or damage if not corrected (Figure 3).
This can be caused by scoliosis, trapezius spasm, or repetitive shoulder use of the dominant arm, which causes increased strength of the rotator cuff and depression of the ipsilateral arm.
The Apley scratch test can be used to evaluate range of motion (preferably while the patient is actively moving around) (Figure 4).
Superiority is the preferred method of evaluation for this test.
The supraspinatus (empty can) test (Figure 5), the subscapularis test (Figure 6), and resisted internal and external rotation should all be performed to determine the strength of the rotator cuff muscles.
A greater amount of testing may be conducted at a sports medicine or orthopedic practice, but it is not always necessary in a general care office environment.
Additional views, such as the trans-scapular Y lateral and axillary views, may be evaluated by a sports medicine physician or orthopedic surgeon, depending on the situation.
When Little League shoulder is suspected, shoulder radiographs may show enlargement of the proximal humeral physis with surrounding sclerosis, particularly along the lateral face of the humerus.
It is possible to have Little League shoulder even when radiographs are symmetric since the patient exhibits discomfort on touch above the proximal humeral physis, which indicates the diagnosis.
However, an MRI is often not required in order to make a diagnosis of Little League shoulder.
2A magnetic resonance (MR) arthrogram should be performed in cases of glenohumeral dislocation, instability, and suspected labral tears in order to examine the fibrocartilaginous labrum in its entirety.
Cost, time, the requirement for gadolinium administration, and the invasive nature of the procedure are all disadvantages of having an MR arthrogram performed (injection into the joint performed by a radiologist).
Twelve of the twenty-three participants in one research who had shoulder magnetic resonance imaging (MRI) conducted on asymptomatic Little League baseball players exhibited positive MRI results on the dominant shoulder as compared to the nondominant shoulder.
Year-round baseball participation and players who solely participate in baseball were found to be risk factors for MRI results.
It is unusual in that ultrasound may provide the potential for dynamic examination while requiring neither anesthesia or exposure to radioactive materials.
It may be possible to allow the athlete to engage in batting as long as the activity does not cause pain to the player.
Physical therapy is essential in order to improve range of motion, posture, and overall strength.
Postural correction can be beneficial in order to bring the shoulders back to a neutral position and minimize forward slumping, which is related with pectoralis tightness and scapular muscular weakening.
The entire course of therapy and return to full play takes around 3 months on average, although it may take longer in some cases.
Pitching with arm fatigue, increased volumes of throwing, pitching on consecutive days, and pitching through discomfort are all characteristics that increase the risk of developing overuse problems in pitchers.
4USA Baseball has created recommendations on maximum pitch counts as well as proper lengths of rest based on the age of the pitcher, which should be observed in order to reduce the danger of overuse injuries.
A pitching coach should examine the mechanics of the pitcher’s throw.
Youth athletes and their families should be educated on the need of not ignoring or trying to play despite upper extremity pain, but rather resting and being examined as soon as possible.
According to the results of a survey conducted among healthy youth baseball players, there are psychosocial effects of arm pain, including decreased enjoyment of the game, and players feel encouraged to continue playing despite arm pain. 1
The effects of arm discomfort in juvenile baseball players: a study of healthy athletes. 1. Makhni EC, Morrow ZS, Luchetti TJ, and colleagues 2015;43(1):41-46 in the American Journal of Sports Medicine. 2: Aoyama et al. Aoyama JT, Maier P, Servaes S, and colleagues Anatomy, pathophysiology, and therapy of the shoulder in youth baseball players using magnetic resonance imaging. Clin Imaging.2019;57:99-109. Abstract: Asymptomatic Little League baseball players had aberrant shoulder MRI findings.
Pennock AT, Dwek J, Levy E, et al.
Four authors: Greenberg EM (lead author), Lawrence JTR (co-author), Fernandez-Fernandez (co-author), and others Physical and functional disparities between youth baseball players who suffer from throwing-related discomfort and those who do not.
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The date was March 17, 2020.