Whether you are a professional athlete, amateur athlete or a sporting person, your body undergoes enormous physical changes, making you more susceptible to injuries especially while throwing.  In sports that involve throwing motion, stress on the shoulder while throwing is a top concern.

Because of the nature of the sports such as baseball, volleyball and tennis, the shoulder stability is challenged through repetitive overhand activity.  High stress during throwing makes the people playing these games susceptible to variety of throwing injuries such as tears, tendinitis, instability and impingement.  Let us learn some of the common shoulder injuries on account of throwing.


Rotator cuff tendinitis and tendon tears:

The rotator cuff is composed of four large muscles that extend from the scapula (shoulder blade) to cover the shoulder joint. These muscles are extremely important for shoulder strength and for holding the shoulder joint in the correct position.  Throwing athletes place tremendous stress on their shoulders and frequent throwing irritates the rotator cuff.  Overworked rotator tendons can be irritated and inflamed.  Rotator cuff tears are prevalent among throwing athletes and swimmers.  When the cuff muscles are weak, a pinching of the bursa and rotator cuff can occur during throwing.
As the symptoms in the beginning are mild, many people will dismiss the condition.  Symptoms may start with mild pain during activity or rest.  As the injury intensifies, tendons are worn down, often resulting in acute pain.  Left untreated, the damage may progress to complete rotator cuff tear.  Typically rotator cuff tears happen within the tendon.

Rotator Cuff Tear Symptoms:

  • Pain during activity or when lifting and lowering the arm
  • Pain during period of rest or while lying on the injured shoulder
  • Weakness, making simple activities like brushing hair, buttoning a shirt or lifting objects difficult or painful
  • Crackling or grinding sensation with movement

At times when conservative treatment fails, surgery is considered to remove the inflamed bursa and create more space for rotator cuff tendons.

SLAP Tears:

Another common ailment that affects the shoulder is SLAP tear which is a type of labral tear.  Labrum is the rubbery cartilage of the shoulder socket which lines and reinforces the ball and socket of the shoulder.  A SLAP (superior labral tear from anterior to posterior) tear happens in the top section of the labrum in which labrum tears away from the socket.  This is a common throwing injury of the shoulder as it is caused by repetitive shoulder motion.  Speedy overhead movement of the shoulder usually triggers off this injury.  However, it can happen gradually as well due to straining, tearing, fraying the labrum or as a part of aging process.

SLAP tear Symptoms:

  • Locking, popping, catching or grinding sensation
  • Feeling of looseness in the shoulder
  • Pain with shoulder movement
  • Decrease in range of motion and strength
  • Difficulty lifting objects

Biceps Tendinitis:

It is also one of those injuries that happens because of repetitive motion of the shoulder.  Biceps tendinitis leads to inflammation and irritation of the upper biceps tendon.  People affected with this injury can experience shoulder weakness and tenderness.

Biceps Tendon tears:

Left untreated or there is no proper rest post biceps tendinitis, the damage may progress to the point of biceps tendon tear.  Sudden sharp pain in the upper arm is the first sign of a biceps tendon tear.  Sometimes a popping or snapping sound can also be heard.

Internal Impingement:

Internal impingement is also referred to as “The Thrower’s Shoulder”.  Youngsters playing baseball are generally susceptible to this injury.  Internal impingement occurs during the “cocking” phase of throwing.  As the player puts the shoulder and arm back, the rotator cuff tendons get pinched between the glenoid labrum and the humeral head.  With time this may progress to a partial rotator cuff tendon tear, or it may harm the labrum.

Shoulder Instability:

It is a throwing injury wherein the instability of the shoulder sets in gradually.  Shoulder instability happens when the tissues in the shoulder are unable to keep the arm centered in the shoulder socket.  Ideally, the head of the humerus bone should normally rest in a shallow socket in the shoulder blade.  As a result of repetitive throwing, ligaments will stretch over time, making the shoulder head slip from the socket more easily.  Pain, numbness and decreased throwing velocity are the signs of this injury.

Glenohumeral Internal Rotation Deficit (GIRD):

Throwing at high speeds require extreme internal rotation causing the ligaments at the front of the shoulder to stretch and loosen, what generally happens then is that the soft tissues in the back of the shoulder tighten, leading to loss of internal rotation.

Scapular Rotation Dysfunction (SICK Scapula):

A throwing motion involves proper movement and rotation of the scapula over the chest wall.  The scapula relies on several muscles in the upper back to keep it in position to support healthy shoulder movement.

During throwing, repetitive use of scapular muscles creates changes in the muscles that affect the position of the scapula and increase the chances of shoulder injury.  Drooping of the affected shoulder coupled with pain at the front of the shoulder, near the collarbone is a clear symptom of scapular rotation dysfunction.

Treatment for throwing injuries of the shoulder often includes rehabilitation exercises designed specially for throwers.  Surgery is considered only as a last resort.

For enquiries related to sports injuries and their treatment options, send a message to www.BangaloreShoulderInstitute.com/contact

Q & A on Throwing Injuries of the Shoulder

1. How do throwing injuries of the shoulder occur?

For a sportsperson, especially those involved in throwing sports, there are great chances of throwing injuries to the shoulder. Due to the continuous stress on the shoulder caused by the throwing motion, the risk of injury is persistent. In sports like throwball, volleyball, baseball, and basketball, the stability of the shoulder is challenged. Injuries like tears, tendinitis, and impingement are some types of damage that can occur in your shoulder. The internal impingement may happen due to looseness in the structure that is at the front of the joint and also some stiffness at the back of the shoulder.

2. What are the symptoms of rotator cuff tear?

The rotator cuff is the group of muscles in the shoulder that help in the movement of arms. Its role is to keep the humerus in the shoulder blade socket. When the tendons pull away from the arm, injuries to the rotator cuff happen. This can be either a partial or complete tear. When there is an accident, it causes a sudden and immediate tear that leads to intense pain. The following symptoms may also be experienced:

  • Pain while raising the hand
  • Popping sounds when the arm is moved
  • Severe shoulder pain when the arm is at rest
  • Weakness of the shoulder leading to inability to lift things

2. What are SLAP tears?

When the cartilage in the inner part of the shoulder joint is facing a tear, it is called SLAP tears. They can be due to an injury or overuse of the shoulder. This is a kind of labral tear wherein the labrum is the rubbery cartilage present in the shoulder socket that reinforces the ball and socket joint. The superior labral tear from anterior to posterior (SLAP) occurs in the top section of the labrum. This is due to the repetitive action of the shoulder and is a common throwing injury of the shoulder.

3. What are the common throwing injuries to the shoulder?

SLAP tears, Biceps tendinitis, Biceps tendon tears, internal impingement, shoulder instability, Glenohumeral internal rotation deficit, and scapular rotation dysfunction. Biceps tendinitis causes inflammation of the upper biceps tendons. When this condition progresses without any treatment, it may lead to a biceps tendon tear. Internal impingement happens during the cocking phase of throwing. Shoulder instability occurs when the shoulder tissues are not able to keep the arm centered in the shoulder socket. When you begin to lose the normal rotational motion of the shoulder, it leads to scapular rotation dysfunction.

4. What is the treatment mechanism for throwing shoulder?

There are both surgical and non-surgical methods of treatment. The non-surgical methods include activity modification, applying ice, taking NSAIDs, physical therapy, cortisone injection, and change of position. The surgical methods are arthroscopy and open surgery. During rehabilitation, you will be advised to wear a sling to keep your arm from moving. Gentle stretches to regain range of motion will be advised after which exercises to strengthen the shoulder muscles and rotator cuff will be prescribed. It may take 2 to 4 months for recovery and more than 6 months to return to sports activities.

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