As the name suggests, Thrower’s shoulder is usually caused by athletic activity and the swinging motion of the arm. It is common in ball sports like cricket, tennis, and tennis, but what exactly is it?
It is usually a result of increased load placed upon the rotator cuff tendons surrounding the shoulder joint. The increased load results from the speed at which we move the arm when throwing or serving in tennis or smashing in badminton and typically occurs with a sudden increase in activity which causes overload.
It usually leads to pain on the front or outside of the shoulder and upper arm. This is due to inflammation of the subacromial bursa causing impingement in the shoulder when the arm is out to the side or above the head.
- Locking, popping, catching or grinding sensation
- Pain with shoulder movement
- Decrease in range of motion and strength
- Difficulty lifting objects
Causes And Risk Factors
The Thrower’s Shoulder is often called Internal impingement and primarily affects younger athletes. Internal impingement occurs during the “cocking” phase of throwing (like a cricket bowler).
As the athlete cocks their shoulder and arm back, the rotator cuff tendons get pinched between the glenoid labrum and the humeral head. This may lead to a partial rotator cuff tendon tear or damage the labrum with time.
Apart from lack of experience, the following risks were identified in a study by Olsen et al. when they surveyed 14-20-year-old baseball players to determine possible risk factors.
Four specific risk factors were identified:
- 5 fold increase for pitchers throwing more than eight months per year.
- 4 fold increase for pitchers throwing more than 80 pitches per game.
- 58 fold increase for pitchers throwing 85mph or higher.
- 36 fold increase for pitchers who often threw despite fatigue
In recent years, there has been more focus on preventing throwing injuries of the shoulder.
- Proper conditioning, technique, and recovery time (periods of rest) can help to prevent throwing injuries.
- Throwers should strive to maintain good shoulder girdle function with proper stretches and upper back and torso (core) strengthening.
- In the case of younger athletes, pitching guidelines — including pitch count limits and required rest recommendations — have been developed to protect children from injury.
- Listen to your body. If your shoulder gets sore after any activity, don’t ignore it. If the pain is severe and doesn’t go away, see your doctor.
- Stay in shape. Keep your body in good physical shape with regular exercise and a healthy diet.
- Exercise the right way. Warm-up before you work out.
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 non-surgical. Treatment options may include:
- Activity modification. Your doctor may first recommend simply changing your daily routine and avoiding activities that cause symptoms.
- Ice. Applying ice packs to the shoulder can reduce any swelling.
- Non-steroidal anti-inflammatory drugs (NSAIDs): Anti-inflammatory drugs like aspirin, ibuprofen, and naproxen can relieve pain and inflammation. They can be provided in a prescription-strength form or purchased over the counter.
- Physical therapy. To improve the range of motion in your shoulder and strengthen the muscles that support the joint, your doctor may recommend specific exercises. Physical therapy can focus on muscles and ligament tightness in the back of the shoulder and help to strengthen the structures in the front of the shoulder. This can relieve stress on any injured structures, such as the labrum or rotator cuff tendon.
- Change of position. Throwing mechanics can be evaluated to correct body positioning that puts excessive stress on injured shoulder structures. Although a change of position or a change in sport can eliminate repetitive stresses on the shoulder and provide lasting relief, this is often undesirable, especially in high-level athletes.
- Cortisone injection. If rest, medications, and physical therapy do not relieve your pain, an injection of a local anaesthetic and a cortisone preparation may be helpful. Cortisone is a very effective anti-inflammatory medicine. Injecting it into the bursa beneath the acromion can provide pain relief for tears or other structural damage. A cortisone injection may relieve painful symptoms.
Non-surgical methods can reduce swelling and alleviate pain, but you might need to consult a surgeon if your condition doesn’t improve even after the treatment.
Your doctor may recommend surgery based on your history, physical examination, and imaging studies, or if your symptoms are not relieved by non-surgical 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. The surgeon inserts a small camera, called an arthroscope, into the shoulder joint during arthroscopy. 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 tiny incisions 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.
During arthroscopy, your surgeon inserts the arthroscope and small instruments into your shoulder joint.
Open surgery. A traditional open surgical incision (several centimetres long) may be required to deal with the injury. Your surgeon will talk to you about which approach is best for you.
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 a short 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, your physical therapist will gradually expand your program by adding exercises to strengthen the shoulder muscles and rotator cuff. This typically occurs 4 to 6 weeks after surgery.
Your doctor will discuss when it is safe to return to sports activity with you. 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 pain relief, but it may take up to a year or more to return to your sports activities.
Shoulder injuries can easily exacerbate if proper treatment and rest schedules are not followed and sometimes require surgical intervention. If you are experiencing any of the above symptoms or can’t find relief with non-surgical methods and home remedies, book an appointment with Dr Reetadyuti Mukhopadhyay, the shoulder specialist at our Saqsham ortho clinic Gurgaon.