Throwing Injuries

Injuries to the upper extremity are a frequent occurrence in the overhead athlete. Ranging from tendonitis in the shoulder or elbow to tears in ligaments and muscles to fractures. The drive and push for our young athletes to become is one contributing factor to the prevalence of these injuries. These injuries are also attributable to poor mechanics and overuse, but there are some measures that can be taken to both prevent injury and improve performance. For this discussion, we will focus on the shoulder.

To understand how to prevent injury and to understand what a physician, athletic trainer or physical therapist is describing when you or your child visits them for injury consultation, you need to have an understanding of the parts of the shoulder. Here is an attempt at translating medical jargon into everyday English.

The shoulder is an extremely complex joint. The bones of the shoulder complex consist of the humerus (arm), scapula (shoulder blade), and the clavicle (collar bone). The top of the arm looks much like a ball. It joins onto the shoulder blade in a very unstable manner. The fit is much like that of a golf ball on a golf tee. Because the contact between the two is so minimal, the shoulder is dependent on the muscles and ligaments around it to provide stability.

The Muscles
The larger muscles that affect the shoulder (the ones that are easily seen and felt) are named the deltoid muscles. Other larger muscles that directly affect the shoulder are the pectoralis (chest muscle) and the latisimus muscle (back muscle). The bicep muscle (the big muscle on the front of the arm) crosses in front of the shoulder joint. The muscles that lie deeper beneath the deltoid are referred to as the rotator cuff. The rotator cuff provides stability to help hold the arm to the shoulder blade when the arm is being moved. The rotator cuff forms a sling around the ball of the shoulder and, when it contracts, pulls the arm against the shoulder blade so it can move properly.

The Tendons and Ligaments
There are many ligaments and ligament like structures that help increase stability in the shoulder. Tendons connect muscle to bone. Ligaments connect bone to bone. Both can become irritated, tight, stretched and torn.

Illustration of shoulder

Injuries to the Shoulder
Here is a list of some of the more common injuries to the shoulder in the overhead athlete:

  1. Rotator Cuff Tendonitis: an overuse injury that can be caused by an improper contraction of some of the muscles in the shoulder, an overpowering of the bigger muscles in the shoulder, tightening of part of the labrum in the shoulder, or by poor mechanics.
  2. Shoulder Impingement: Occasionally, abnormal movement in the shoulder complex will cause the rotator cuff or bursa in the shoulder to rub against the front edge of the shoulder blade and cause irritation. If the tendons are irritated enough, you develop tendonitis. If the bursa is irritated enough, you develop bursitis.
  3. Biceps Tendonitis: The mechanism of injury is similar to that of rotator cuff tendonitis.
  4. SLAP Tear: The acronym “SLAP” stands for Superior Labrum Anterior Posterior. It is an injury that involves tearing or fraying of both the front and back of the labrum of the shoulder.  Often, it will involve the biceps tendon. It is a complicated injury because it involves both tendon and ligament.
  5. Rotator Cuff Tear: A tear in the rotator cuff does not necessarily mean a direct route to the operating table. When the rotator cuff has a tear in it, the ability for the arm to be held to the shoulder blade is altered. Depending on the size and location of the tear, Physical Therapy may resolve the problem. I try to look at rotator cuff tears like this: it is either functional or not. What I mean is that once the appropriate means have been tried to fix it conservatively, it either will or will not perform the way you need it to. If it does not, you will discuss additional options (surgery) with your physician.

Diagnosis
The diagnosis of an injury is made by the Physician or Physical Therapist doing a clinical examination. If there is a question to the exact injury or if there was a traumatic injury, additional testing such as an X-ray or MRI may be ordered by the physician. Each of the injuries in the shoulder has a specific set of guidelines that will help determine what the injury is.

Treatment
Once a diagnosis is made, proper treatment can be initiated. Because the problems listed above are the result of mechanical faults in the shoulder complex, in order for the problem and pain to resolve, correcting muscle imbalances and re-training the muscles how to work together is of utmost importance.

While modalities such as ice, heat, electric stimulation and ultrasound may be used to help calm down any inflammation that is present, correcting the imbalances often require a patient-specific series of stretching and strengthening exercises that need to be completed both in the clinic and at home.

Some of the techniques that are included are exercises to strengthen the rotator cuff and scapular stabilizing muscles. The Graston technique and Kinesiotaping may also be used to help free any adhesions that may be restricting motion or facilitate specific muscle to contract of relax. Lastly, your Rehab Connection Physical Therapist will use manual resistance or stretching and joint mobilizations techniques to help recreate the appropriate muscle balance.

For more information on treatment options for your shoulder, or any orthopedic or neurological condition, please contact one of your family and neighborhood physical therapists at Rehab Connection.