throwing injuries of the shoulder

There are some injuries that occur in the thrower's shoulder that do not occur in other shoulders. Thus the shoulder surgeon diagnosing, treating, and attempting to prevent these injuries must have a specific understanding of this unique spectrum of disorders. Each injury or condition below is followed by a short description, or can be clicked for a more extensive description.

Posterior Capsular Tightness - surgery photos available!
The shoulder capsule gets tough and tight in one certain spot (ligament A in this diagram), and this can lead to serious injury to the shoulder of overhead throwers.

Little Leaguer's Shoulder
The ball of the ball and socket has a growth zone that can be injured from a lot of hard throwing over time. If this occurs, 2-3 months of rest without throwing is often needed to recover and 4-5 months to return to full throwing.

Labral Tears, or SLAP tears - surgery photos available!
The labrum is the circular cartilage that encircles the socket, and is seen in the bottom 2 diagrams on the anatomy page. If posterior capsule tightness is ignored and is left untreated, tearing of the labrum will occur and can end the season or even career of overhead throwers.

Rotator Cuff Tears
The rotator cuff is actually tendons and muscles that serve to center the ball in the socket during motion. If one or more of these tendons tears, serious disability for the overhead thrower occurs.

Internal Impingement Syndrome
The undersurface of the rotator cuff can rub against the upper surface of the labrum and cause partial or even complete tearing of both structures. This is very disabling for the overhead thrower, and usually requires surgery.

Anterior Instability - surgery photos available!
The ligaments in front of the shoulder, indicated by B and C in this diagram, can stretch by the repeated thowing motion. This causes a looseness and slipping feeling in the shoulder and requires surgery in most cases to get throwers back to throwing well.

Dislocation- surgery photos available!
The ball actually comes all of the way out of the socket. This is unusual from throwing only, as it normally requires a significant trauma like headfirst slide into base twisting the arm badly.

Bone Changes
The normal shoulder is retroverted (twisted backwards) a little, and this decreases as we grow until we are about 18-20. During growth, the youth throwing shoulder does not have this normal decrease in retroversion, and permanent bone changes occur. To our knowledge, this is not associated with injury but does explain part of the difference in movement of the throwing versus the non-throwing shoulder.

Long Thoracic Nerve Palsy
The long thoracic nerve provides power to the main muscle which stabilizes the scapula. That muscle is called the serratus anterior, and when the nerve is injured, the shoulder blade sticks out in the back. This normally resolves on its own but can take many months, and occasionally can require surgery.

Brachial Neuritis
The long thoracic nerve provides power to the main muscle which stabilizes the scapula. That muscle is called the serratus anterior, and when the nerve is injured, the shoulder blade sticks out in the back. This normally resolves on its own but can take many months, and occasionally can require surgery.

Paget-Schroetter Syndrome (Effort induced upper extremity thrombosis)
The primary vein draining blood from the arm to the heart becomes compressed by repeated throwing, and the blood clots right inside the vein, blocking that very flow.