The act of throwing a baseball is one of the fastest and most violent maneuvers to which any joint in the body can be subjected. For each pitch, the thrower must generate high levels of energy in the legs and trunk to accelerate the ball to top velocity, requiring the muscles and structures of the shoulder to effectively dissipate the burst of force after the ball is released.
As you can imagine, pitching a baseball, or any type of overhand throwing, places extremely high stresses on the shoulder. Specifically, stress is placed on the anatomy that keeps the shoulder stable. The rotator cuff and labrum are the structures most vulnerable to throwing injuries, although a wide range of shoulder injuries are possible. And, baseball pitchers are not the only athletes at risk for throwing injuries. Any athlete who participates in sports that require repetitive overhand motions, such as volleyball and tennis, are also at risk.
Anatomy
To understand shoulder injuries, it is important to have a basic understanding of how your shoulder works and what structures keep it stable. Your shoulder, similar to your hip, is a ball and socket joint. The head of your upper arm bone (humerus) fits into a rounded socket (glenoid) in your shoulder blade. Surrounding the outside edge of the socket is a rim of strong tissue called the labrum which helps to stabilize the shoulder joint. It also serves as an attachment point for many of the ligaments of the shoulder, as well as one of the tendons from the biceps muscle in the arm.
Strong connective tissue, called the shoulder capsule, is the ligament system of the shoulder and keeps the head of the upper arm bone centered in the glenoid socket. This tissue covers the shoulder joint and attaches the upper end of the arm bone to the shoulder blade.
Your shoulder also relies on strong tendons and muscles to keep your shoulder stable. Some of these muscles are called the rotator cuff. The rotator cuff is made up of four muscles that come together as tendons to form a covering or cuff of tissue around the head of the humerus.
Injuries
Although injury types can vary widely, some common injuries of throwing athletes include:
• Bicep Tendinitis and Tendon Tears. Repetitive throwing can inflame and irritate the upper biceps tendon. This is called biceps tendinitis. Pain in the front of the shoulder and weakness are common symptoms of biceps tendinitis. Occasionally, the damage to the tendon caused by tendinitis can also result in a tendon tear.
• Rotator Cuff Tendinitis and Tears. When a muscle or tendon is overworked, it can become inflamed. The rotator cuff is frequently irritated in throwers, resulting in tendinitis. Rotator cuff tears often begin by fraying. As the damage worsens, the tendon can tear.
• SLAP Tears (Superior Labrum Anterior to Posterior). In a SLAP injury, the top (superior) part of the labrum is injured. This top area is also where the long head of the biceps tendon attaches to the labrum. A SLAP tear occurs both in front (anterior) and in back (posterior) of this attachment point.
• Instability. Shoulder instability occurs when the head of the humerus slips out of the shoulder socket (dislocation). In throwers, instability develops gradually over years from repetitive throwing that stretches the ligaments and creates increased laxity (looseness). If the rotator cuff structures are not able to control the laxity, then the shoulder will slip slightly off-center (subluxation) during the throwing motion.
Treatment
Treatment of the overhead throwing athlete is one of the more challenging aspects of orthopaedic sports medicine. In many cases, the initial treatment for a throwing injury in the shoulder is nonsurgical. These treatment options may include activity modification, ice, anti-inflammatory medication, change in throwing mechanics, cortisone injection, or physical therapy.
In some instances, however, based on your history, physical examination, imaging studies, or if your symptoms are not relieved by nonsurgical treatment, your doctor may recommend surgery. The type of surgery performed will depend on several factors, such as your injury, age, and anatomy. Your orthopaedic surgeon will discuss with you the best procedure to meet your individual health needs.
Prevention
Attention to throwing mechanics and appropriate stretching, strength, and conditioning programs may reduce the risk of injury in this highly demanding activity. Early discovery of symptoms, followed by conservative management with rest and rehabilitation with special attention to retraining mechanics may mitigate the need for surgery. Prevention of injury is always more beneficial to the long-term health of the athlete than is surgical repair. A coordinated approach among trainers, therapists, and physicians is required for the comprehensive evaluation, diagnosis, and treatment of shoulder pain in the throwing athlete.
Dr. James Shaffer, board certified orthopedic surgeon, offers years of experience working with athletes in the effective treatment of sports-related injuries affecting the shoulder. His expertise, combined with Arthritis and Joint Replacement Center of Reading’s Continuum of Joint Care™, creates a coordinated approach between physician and physical therapist necessary for the optimal treatment of shoulder injuries.
Don’t let a shoulder injury sideline your activities. Contact Dr. James Shaffer for an appointment today.
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To your wellness,
AJRC
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