Throwing Shoulder Injuries
The overhead throwing athlete subjects the shoulder to extreme forces. The shoulder anatomy is designed to maintain shoulder stability. When repeatedly stressed, the anatomy may undergo damaging structural changes resulting in altered shoulder biomechanics.
Baseball pitching, tennis, volleyball, javelin, and football all exhibit similar throwing arcs resulting in similar injuries. Throwing athletes, especially pitchers, from the Little League to the Major leagues are at risk for activity- related shoulder injuries.
Treatment of the overhead athlete is challenging. It requires a thorough understanding of the throwing motion and the forces imposed on the shoulder structures. Dr. Jeffrey Harrison is a sports medicine physician with the knowledge and experience to help throwing athletes. Together with the coach, trainers, and therapists; a team approach is used to treat and rehabilitate the athlete back to their sport.
The shoulder is a ball and socket joint made of 2 bones the upper arm bone (the humerus) that sits in the socket in the shoulder blade (the scapula).The socket is smaller and shallower than the ball. The ball sits in its socket like a golf ball on a tee. To deepen the socket, nature created a cartilage rim called the labrum to stabilize the joint. The labrum is where the shoulder ligaments and the biceps tendons attach.
Wrapped around this network of ligaments is the shoulder capsule, tough connective tissue that is designed to keep the ball in its socket and attaches the upper arm bone to the shoulder blade. In addition, there is the rotator cuff made of four muscles and their tendons that form a cuff of tissue around the ball. The biceps muscle has two heads, the long and short heads. The long head attaches to the top of the shoulder socket. Finally, there is the shoulder girdle which is the foundation of the shoulder joint.
Common shoulder throwing injuries include:
- Rotator cuff injuries – Rotator cuff injuries are common in throwing sports. They result from microtrauma generated by repetitive motions and internal impingement. This causes tendinitis, inflammation of the cuff tendon that can lead to partial and degenerative full thickness tears. It can also cause bursitis. Symptoms include sharp pain at the shoulder that radiates down into the arm from the shoulder, and pain with activity and rest.
- SLAP tears of the shoulder labrum – A SLAP tear is a tear at the top of the shoulder near where the long head of the biceps muscle attaches. Symptoms are catching and locking, and deep pain with overhead motions.
- Biceps tendon injuries – Repetitive overhead motions can cause inflammation of the tendon of the long head of the biceps muscle. This can lead to tendon degeneration and a tear of the biceps Symptoms of a biceps tendon tear include a sudden, sharp pain in the front of the shoulder, swelling, bruising, and popping or snapping when the tendon tears.
- Internal impingement – Impingement occurs when the rotator cuff tendon is pinched between the ball and the socket at the back of the shoulder. It can tear the rotator cuff tendon and damage the labrum. Symptoms include posterior shoulder pain and stiffness, decline in performance, loss of control and velocity.
- Instability – Throwing athletes place high stress on the anatomy that keeps the shoulder stable. Repetitive throwing motions stretch ligaments causing laxity and instability and can lead to subluxation when the shoulder to slips off center. Pain and loss of throwing velocity are symptoms.
- Glenohumeral Internal Rotation Deficit (GIRD) – High speed throwing causes extreme stress on the ligaments at the front of the shoulder causing them to stretch. This results in the tightening of the posterior capsule and rotator cuff tissues at the back of the shoulder which causes a loss of internal rotation. GIRD increases the risk of labral and rotator cuff tears. Symptoms include vague shoulder pain and decreased throwing performance.
- Scapular rotation dysfunction (SICK Scapula) – During throwing repetitive use of the scapular muscles changes the position of the scapula, increases the risk of shoulder injuries, causes poor shoulder mechanics and limits range of motion. Symptoms include a drooping shoulder and pain the front of the shoulder.
Contact Dr. Jeffrey Harrison to schedule a consultation to learn about what is causing your shoulder pain and your treatment options.
Dr. Harrison is a board-certified fellowship trained orthopedic and sports medicine surgeon who specializes in arthroscopic knee and shoulder surgery. He is the Head Team Physician for the United States Alpine Ski Team, the Chief of Sports Medicine at McKay-Dee Hospital, and the Head Team Physician for Weber State University for over 20 years. Dr. Harrison completed his undergraduate degree at Baylor University and received his medical degree from the University of Arizona College of Medicine. He completed his orthopedic residency at the University of Utah followed by a fellowship in sports medicine at the Cincinnati Sports Medicine and Orthopedic Center and finished with an additional AO Trauma Fellowship in Bern, Switzerland.
At a Glance
Dr. Jeffrey Harrison
- Board-Certified, Fellowship-Trained Orthopedic Surgeon
- Head Team Physician US Women's Alpine Team and Weber State University
- Performs over 800 surgeries per year
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