All walks of life, athletic vs. non-athletic, and all types of athletes can sustain shoulder injuries; however, with the throwing athlete there are certain injuries more prevalent than others. In addition, the injured shoulder in the thrower can have a much different prognosis than the non-thrower.
Common Shoulder Injuries Related to Throwing or Pitching
The following are some common injuries in this population of athletes with the generally recommended treatment plans and prognoses:
Bicipital Tendinitis: This is generally brought on by chronic overuse and/or poor throwing mechanics. Generally treated non-operatively with rest, ice, NSAIDS, rehab with re-education of proper throwing mechanics. Prognosis is good for full recovery.
A-C Joint Separations: Generally seen in the quarterback after being tackled and his shoulder pile-driven into the turf. Depending on the severity, it can be treated non-operatively (rest, sling, pain meds) or operatively with the more severe cases. Regardless, unless it is a very mild separation, return to play is very unlikely for the current season; however, prognosis is good for future play.
SLAP Tears: This stands for Superior Labral Anterior Posterior tear. It represents the top, or superior, portion of the glenoid socket where the biceps tendon inserts. Again, it too occurs from repetitive throwing and many times is associated with poorer mechanics. It is always a good practice to try several weeks of non-operative treatment, but many times this will prove to be unsuccessful. If so, surgical fixation is recommended. Recovery time in the throwing athlete can be 6-12 months before ever throwing again and up to 2 years before the throwing athlete can expect to return to form. Even so, the prognosis is moderate. (Previous studies on professional baseball pitchers showed that only 2/3 returned to previous form.)
Rotator Cuff Tendinitis & Tears: When we think of shoulder injuries, the classic one is the rotator cuff tear; however, in the young, healthy throwing athlete minus any direct trauma to the shoulder, it is unusual unless associated and secondary to a SLAP tear. For actual tears, the treatment and prognosis is very similar to SLAP tears. Similarly, RC tendinitis is treated the same as bicipital tendinitis.
GIRD: This stands for Glenohumeral Internal Rotation Deficit. One of the intrinsic developments that can happen with throwers is the loss of internal rotation of the throwing arm and its shoulder girdle. This can cause a domino effect of placing stress on the biceps-labrum complex, elevating the humeral head in a superior-posterior direction, and causing a rotator cuff tear. It’s important for any thrower to emphasize internal rotation stretching (ask your sports med doc about the Sleeper Stretch). Generally, this is a purely non-operative issue with a good prognosis as the thrower’s internal rotation improves.
For more information on treating pitching or throwing related injuries be sure to check out a previous post written by Dr. Terry Gemas titled “Using Physical Therapy as a Treatment for Pitching Injuries“.