Injuries in the Throwing Shoulder
Thomas E. Anderson, M.D.Cleveland Clinic Sports Health
Spring brings baseball and softball season - and a time for the throwing athlete to take heed of injuries that can occur in the throwing shoulder.
Several chronic conditions commonly result in shoulder pain in the throwing athlete. These conditions are tendinitis, bursitis, impingement and subluxation.
Warning Signs
Typically, the athlete complains of shoulder pain that has become progressively worse. Initially, the pain may be present only when throwing and for a short time afterward; however, it disappears by the next day. As the condition gets more serious, the pain progresses to the point where it is present before, during and after activity. The athlete eventually becomes unable to throw at all due to the pain.
Tendinitis, bursitis, impingement and subluxation are closely related. All of them may cause pain in the same area, making it difficult to tell which developed first. The pain may start in the tendon or in a pinched bursa (small cushion that allows tendons to move over the bone as they contract and relax) next to the tendon.
Rotator cuff tendinitis in the throwing athlete occurs when the tendon becomes irritated as it rubs on the undersurface of the shoulder. This causes the tendon to tear and become inflamed.
Similarly, bursitis results from the repeated pinching of the bursae between the shoulder structures. As the bursae swell, it puts additional pressure on the area that already is inflamed.
The combination of rotator cuff tendinitis, bursitis and the limited area in the shoulder may result in a condition called impingement. Pain and weakness with overhead arm movements are often a sign of shoulder impingement.
Subluxation is a condition in which the shoulder slips partially out of joint, then returns to its original position, causing instability of the shoulder joint. It may occur with a traumatic event, such as a fall, or with the development of impingement and bursitis. This type of subluxation is often related to fatigued muscles in the shoulder. The athlete continues throwing even as fatigue sets in. As the arm tires, the muscles cannot stabilize the shoulder, and this results in subluxing.
A final, secondary shoulder injury may occur as a result of changing the throwing motion to compensate for the pain of the original condition.
These are just some of the problems that the throwing athlete may experience. Since they are primarily related to overuse, they can be relieved by having the athlete rest the shoulder to provide time for healing; by strengthening, stretching and building muscular endurance; and by putting the athlete on a throwing program that includes a warm-up and a gradual return to throwing after a long layoff.