Shoulder injuries and athletics are a common pairing especially in overhead sports such as baseball. Repetitive overhead stress activities like pitching place significant forces across the shoulder that may result in microtears which over time can culminate in injury.
The shoulder is a complex machine with the most freedom of motion of any joint in the body. A series of anatomic structures ranging from bony architecture to muscles, labrum, and capsule, all work in synergy to provide stability, strength, and the ability to throw a ball. If one of these structures weakens, stress loads are increased in the others, which can eventually cause damage.
Typical symptoms of shoulder injury commonly begin as pain in addition to a sense of popping or instability; however, at times, these symptoms may be as innocuous as loss of motion or even endurance and velocity of pitches.
Some of the most common injuries seen in pitchers involve the rotator cuff, biceps tendon, labrum, and scapula. Lateral or posterior pain may stem from rotator cuff tendinitis or even tears, and can occur with improper mechanics and strength. Tendinitis and tears to the biceps tendon or its attachment to the glenoid (SLAP tears), may manifest as sharp, deep anterior to posterior pain and popping. Increased tightness or laxity and muscle imbalance may lead to Glenohumeral Internal Rotation Deficit (GIRD) and Scapular Rotation Dysfunction (SICK Scapula), as well as instability issues and “dead arm” feeling after throwing. While these issues can occur in both the adult and adolescent thrower, a unique condition causing pain in the shoulder in the pediatric athlete, involves the shoulder growth plate as a result of improper pitch count monitoring.
The most important way to treat shoulder injuries in the throwing athlete is to prevent their occurrence all together. Proper strength and stretching programs, pitching mechanics, and pitch counts begin at the individual and team level involving the athlete and coaches. Whenever symptoms first occur, they are usually assessed by the team trainer. Most times, they can be corrected at their early onset with a quick return to sport. Occasionally, they require evaluation by the team doctor to help coordinate a plan for return to pitching. This should always involve cessation of pitching until appropriate medical evaluation is completed. Most commonly, a physical therapy program coupled with treatment modalities such as anti-inflammatory pain medications, ice, and heat, is all that is necessary to treat the affected athlete. Occasionally, corticosteroid injections are required to augment the therapy program. Rarely, surgical intervention is required to fix tears or conditions that have not responded to more conservative management.
In summary, shoulder injuries in throwing athletes are not uncommon, however, they are usually preventable. A proper supervised program of pre and post activity stretches, in and offseason strengthening, pitching mechanics, and pitch count all play a role in injury prevention. A team approach involving the athlete, coaching staff, trainers, and team physicians is required to identify at risk athletes, appropriately treat them, and return them to their sport as quickly and safely as possible.