Overhand throwing places extremely high stresses on the shoulder, specifically to the anatomy that keeps the shoulder stable. In throwing athletes, these high stresses are repeated many times and can lead to a wide range of overuse injuries.
When athletes throw repeatedly at high speed, significant stresses are placed on the anatomical structures that keep the humeral head centered in the glenoid socket.
Of the five phases that make up the pitching motion, the late cocking and follow-through phases place the greatest forces on the shoulder.
When one structure — such as the ligament system — becomes weakened due to repetitive stresses, other structures must handle the overload. As a result, a wide range of shoulder injuries can occur in the throwing athlete.
The rotator cuff and labrum are the shoulder structures most vulnerable to throwing injuries.
Left untreated, throwing injuries in the shoulder can become complicated conditions.
In many cases, the initial treatment for a throwing injury in the shoulder is nonsurgical. Treatment options may include:
Your doctor may recommend surgery based on your history, physical examination, and imaging studies, or if your symptoms are not relieved by nonsurgical treatment.
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.
Arthroscopy. Most throwing injuries can be treated with arthroscopic surgery. During arthroscopy, the surgeon inserts a small camera, called an arthroscope, into the shoulder joint. The camera displays pictures on a television screen, and the surgeon uses these images to guide miniature surgical instruments.
Because the arthroscope and surgical instruments are thin, the surgeon can use very small incisions (cuts), rather than the larger incision needed for standard, open surgery.
During arthroscopy, your doctor can repair damage to soft tissues, such as the labrum, ligaments, or rotator cuff.
Open surgery. A traditional open surgical incision (several centimeters long) is often required if the injury is large or complex.
Rehabilitation. After surgery, the repair needs to be protected while the injury heals. To keep your arm from moving, you will most likely use a sling for for a short period of time. How long you require a sling depends upon the severity of your injury.
As soon as your comfort allows, your doctor may remove the sling to begin a physical therapy program.
In general, a therapy program focuses first on flexibility. Gentle stretches will improve your range of motion and prevent stiffness in your shoulder. As healing progresses, exercises to strengthen the shoulder muscles and the rotator cuff will gradually be added to your program. This typically occurs 4 to 6 weeks after surgery.
Your doctor will discuss with you when it is safe to return to sports activity. If your goal is to return to overhead sports activities, your doctor or physical therapist will direct a therapy program that includes a gradual return to throwing.
It typically takes 2 to 4 months to achieve complete relief of pain, but it may take up to a year to return to your sports activities.
In recent years, there has been a great deal of attention on preventing throwing injuries of the shoulder.
Proper conditioning, technique, and recovery time can help to prevent throwing injuries. Throwers should strive to maintain good shoulder girdle function with proper stretches and upper back and torso strengthening.
In the case of younger athletes, pitching guidelines regarding number of pitches per game and week, as well as type of pitches thrown, have been developed to protect children from injury.