Don't Throw Out Your Shoulder
Athletes that use a throwing motion are particularly susceptible to shoulder injuries. This includes the obvious baseball and softball throwers, but also tennis players and volleyball players. The tennis serve and overhead slam are mechanically very similar to throwing. In volleyball, the spike and overhead serve also use the same mechanics.
The anatomy of the shoulder is what makes it susceptible to repetitive overuse injuries. It is a ball-in-socket joint, but has been more appropriately described as a golf ball-on-tee joint. The relatively large ball on such a small cup makes for a highly mobile joint, and inherently unstable joint. The stability of the joint actually is imparted by the surrounding soft tissues, which include a complex array of ligaments, a cartilage ring called the labrum, and the dynamic stabilizers known as the rotator cuff. The rotator cuff is actually comprised of four muscular tendons, including the supraspinatous, infraspinatous, subscapularis, and teres minor. During adolescence, the addition of cartilaginous growth plates about the ball of the humerus bone increases the opportunity for injury, as the cartilage is weaker than the bone.
Most injuries occur when the delicate balance of these stabilizing structures is disturbed. The most clear example of this would be repetitively overusing the shoulder to the extent that the dynamic stabilizers fatigue. Once the rotator cuff is fatigued the mechanics of the joint can be affected to the point that real damage can be imparted to the ligaments, labrum, and even the bone. Evidence of this mechanical breakdown shows up as loss of control, loss of power, and/or loss of velocity. Pain will often follow this.
Prevention of this should be relatively self-evident. The rotator cuff should not be taken to the point of irrecoverable fatigue. This means tight control of pitch counts and practice time, more time for recuperation, and pre-participatory strengthening programs that target the rotator cuff.
Once pain develops, it should be taken very seriously, as problems can escalate quickly. Coaches and parents should regularly ask their young athletes about shoulder pain, as prevention is the best course of treatment. If pain becomes consistent, then medical assistance should be sought. Shoulders are not that well understood in the medical community, so a sports medicine specialist should be involved. Initial evaluation involves a thorough history of the development of the pain, an examination of the shoulder, and plain x-rays. Sometimes MRI's will be necessary. If it is determined that the growth plate is involved in the adolescent, then an average of 3 months rest will be required, with a slow return to throwing sports. Sometimes a course of formal physical therapy can alleviate the pain and restore strength to the rotator cuff, restoring normal mechanics to the shoulder. If inadequate therapy is done, then the mechanics will not be restored and recurrent problems should be expected.
Rarely, in the young athlete, will surgery be required. Rotator cuff tears simply do not occur in this age group. More commonly in this age group, surgery would be required for instability created by previous dislocations. Dislocations of the shoulder in younger individuals usually results in tears of the ligaments and the cartilage labrum. These tears rarely heal themselves, rendering the shoulder permanently less stable.
In conclusion, we should protect our shoulders to avoid long drawn out treatments. The prevention is not complicated. Signs of problems should be monitored closely. Contact a Sports medicine specialist at the first signs of persistent pain.
