Throwing places high repetitive forces across the shoulder, resulting in common patterns of injury. Improper training, poor mechanics, or an acute event can all cause injury to the shoulder.
What Are Throwing Injuries?
Throwing places high repetitive forces across the shoulder. Common shoulder injuries in throwers include:
- Subacromial impingement and rotator cuff tendonitis
- Posterior capsular tightness with glenohumeral (shoulder) internal rotation deficit (GIRD)
- Imbalance in internal versus external rotational strength
- Proximal humeral physeal stress fracture/epiphysitis (Little League shoulder)
- Internal impingement
- Micro-instability
- Superior labral tears
- Partial thickness rotator cuff tears
- Scapular dyskinesis (abnormal movement)
Traditional rehabilitation exercises are designed to increase the strength and endurance of the muscular stabilizers of the shoulder. However, these exercises cannot reproduce the extreme forces and torques seen at the shoulder and elbow during throwing. Throwing is therefore necessary to train in the preseason, maintain during the off- and in-season, and return to play after an injury.
Causes and Risk Factors
Causes include:
- Repetitive overhead use
- Throwing beyond recommended pitch counts
- Training errors
- Insufficient recovery time or rest
- Poor mechanics
Risk factors include:
- Repetitive overhead motion sports
- Prolonged sports seasons without adequate rest or downtime
- Poor throwing mechanics
- Multiple showcase events
- Poor physical conditioning, including strength and flexibility
- Rapid skeletal growth
Symptoms
Signs and symptoms may include:
- Gradual onset of pain with throwing
- Pain with a single hard throw
- Weakness or inability to use the injured arm in athletic activities
- Pain with throwing
- Loss of velocity and accuracy of throwing
Treatment
Whenever throwing or overhead athletes develop shoulder pain, they should rest from throwing until proper diagnosis and treatment successfully correct the problem.
For most conditions, including impingement, rotator cuff tendonitis, posterior capsular tightness, strength imbalances, early internal impingement, and scapular dyskinesis, conservative treatment including physical therapy and correction of throwing mechanics is often successful.
For stress injuries to the growth plate, as occurs with Little League shoulder, three to six weeks and sometimes up to three months of rest from throwing is required, followed by physical therapy and a gradual return to throwing.
For structural injury to the labrum or rotator cuff, arthroscopic surgery is often needed to repair the injury, followed by physical therapy.
After treatment of shoulder throwing injuries, a gradual resumption of throwing activities with a strict interval throwing program is required to allow a safe and injury-free return.
Recovery and Outcomes
For most throwing injuries, conservative treatment consisting of rest, physical therapy, and modalities can help reduce symptoms and return the athlete to their sport.
Some cases that fail conservative treatment may require surgical intervention, which can usually be performed arthroscopically.
Recovery depends on the type of throwing injury. For growth plate stress injuries such as Little League shoulder, three to six weeks and sometimes up to three months of rest from throwing is required, followed by physical therapy and a gradual return to throwing.
When to See Dr. Chudik
Notify Dr. Chudik’s office if symptoms worsen.Call 630-324-0402 or request an appointment online.