An overhead athlete is at increased risk of injury to the shoulder due to the mechanism associated with rapid shoulder elevation, external rotation, and abduction. An overhead throwing motion is an intricate and skilful movement that presents a special challenge of needing the glenohumeral joint to surpass its physiologic limits during overhead sports activities.

Athletes involved in overhead sports such as baseball, American football, tennis, volleyball, swimming, and other repetitive throwing sports apply immense force across their shoulders and are at increased risk of developing overhead shoulder injuries. An overhead injury may occur due to improper techniques, training errors, shoulder instability, shoulder imbalance, and overuse of muscles surrounding the shoulder.

Types of Overhead Athlete’s Shoulder Injuries

Athletes in sports such as baseball, tennis, and swimming are more susceptible to overhead athlete’s shoulder injuries that include:

  • SLAP Tears: In a slap injury, the superior part of the shoulder labrum is injured. The labrum is a rim of tough fibrous tissue that stabilizes the shoulder joint. This type of injury commonly occurs in sports with overhead motions such as baseball.
  • Biceps Tendon Tears and/or Biceps Tendinitis: Repetitive throwing movement may lead to irritation and inflammation of the biceps tendon known as biceps tendinitis. Damage to the tendon may also result in a tear leading to a torn biceps tendon.
  • Rotator Cuff Tears and Tendinitis: Overuse of the rotator cuff muscles or tendons may result in a rotator cuff tear or tendinitis. This is most commonly observed in throwers due to repeated high-speed throwing activity that adds significant stress on the ligaments and rotator cuff tendons of the shoulder. It usually results from (external) impingement of the rotator cuff in the narrow space through which the tendons run (subacromial space). In this space there is a bursa to help cushion the tendons but if pinched or irritated this bursa can become very inflamed.
  • Internal Impingement: During an overhand throwing action, the rotator cuff tendons at the back of the shoulder can also get pinched between the humeral head and the glenoid socket. This is known as internal impingement and can lead to partial tearing of the rotator cuff tendon and may also damage the shoulder labrum.
  • Instability: Shoulder instability happens when the humeral head slips out of the shoulder socket resulting in dislocation. This is seen in throwers where the instability occurs due to repetitive throwing motions that stretch the ligaments causing increased laxity (looseness).
  • Scapular Rotation Dysfunction: This type of injury is mostly noted in throwers where the repeated use of scapular muscles leads to changes in the muscles that affect the position of the scapula resulting in drooping of the affected shoulder.
  • Glenohumeral Internal Rotation Deficit (GIRD): In this type of injury, soft tissues in the back of the shoulder tighten leading to loss of internal rotation due to high-speed repetitive throwing action noted in throwers. This puts throwers at greater risk of rotator cuff and labral tears.

Diagnosis of Overhead Athlete’s Shoulder Injuries

Your doctor will review your symptoms and medical history and perform a physical examination to check for range of motion, stability, and strength of your shoulder. If necessary, your doctor will order certain imaging tests such as X-rays, MRI, CT scan, or ultrasound to confirm the source of pain and narrow down any associated problems.

Treatment for Overhead Athlete’s Shoulder Injuries

Treatments for overhead athlete’s shoulder injuries include both surgical as well as non-surgical options. Your doctor will decide the best option for you based on the condition of your shoulder.

The nonsurgical treatment options may include:

Ice: Application of ice packs on the shoulder to decrease swelling and pain

Activity Modification: Avoiding activities that trigger symptoms and changing your lifestyle

Physical Therapy: Regular exercise regimen to improve range of motion and strengthen shoulder muscles

Anti-inflammatory Medication: Medications like naproxen and ibuprofen can relieve inflammation and pain.

Cortisone Injection: If physical therapy, medications, rest, and activity modification do not yield the desired results, then a cortisone injection may be helpful. Cortisone is a very effective anti-inflammatory medicine for bursitis and long-term pain reliever for tears and structural damage.

The surgical treatment options may include:

Arthroscopy: Most throwing injuries can be treated with arthroscopic surgery, but this tends to be a last resort Ideally the aim would be to treat your shoulder injury without surgery, as it can be very difficult to get an athlete back to the same level of throwing activity even after successful shoulder surgery. Although your doctor will be able to repair damage to soft tissues, such as ligaments, labrum, or rotator cuff tears by using this technique, there is always a very prolonged recovery period afterwards and return to throwing sports can be difficult.

Other Shoulder Conditions