Throwing Injuries of the Shoulder

Rotator cuff tendinitis and tendon tears:

The rotator cuff is composed of four large muscles that extend from the scapula (shoulder blade) to cover the shoulder joint. These muscles are extremely important for shoulder strength and for holding the shoulder joint in the correct position.  Throwing athletes place tremendous stress on their shoulders and frequent throwing irritates the rotator cuff.  Overworked rotator tendons can be irritated and inflamed.  Rotator cuff tears are prevalent among throwing athletes and swimmers.  When the cuff muscles are weak, a pinching of the bursa and rotator cuff can occur during throwing.
As the symptoms in the beginning are mild, many people will dismiss the condition.  Symptoms may start with mild pain during activity or rest.  As the injury intensifies, tendons are worn down, often resulting in acute pain.  Left untreated, the damage may progress to complete rotator cuff tear.  Typically rotator cuff tears happen within the tendon.

Rotator Cuff Tear Symptoms:

• Pain during activity or when lifting and lowering the arm
• Pain during period of rest or while lying on the injured shoulder
• Weakness, making simple activities like brushing hair, buttoning a shirt or lifting objects difficult or painful
• Crackling or grinding sensation with movement

At times when conservative treatment fails, surgery is considered to remove the inflamed bursa and create more space for rotator cuff tendons.

SLAP Tears:

Another common ailment that affects the shoulder is SLAP tear which is a type of labral tear.  Labrum is the rubbery cartilage of the shoulder socket which lines and reinforces the ball and socket of the shoulder.  A SLAP (superior labral tear from anterior to posterior) tear happens in the top section of the labrum in which labrum tears away from the socket.  This is a common throwing injury of the shoulder as it is caused by repetitive shoulder motion.  Speedy overhead movement of the shoulder usually triggers off this injury.  However, it can happen gradually as well due to straining, tearing, fraying the labrum or as a part of aging process.

SLAP tear Symptoms:

• Locking, popping, catching or grinding sensation
• Feeling of looseness in the shoulder
• Pain with shoulder movement
• Decrease in range of motion and strength
• Difficulty lifting objects

Biceps Tendinitis:

It is also one of those injuries that happens because of repetitive motion of the shoulder.  Biceps tendinitis leads to inflammation and irritation of the upper biceps tendon.  People affected with this injury can experience shoulder weakness and tenderness.

Biceps Tendon tears:

Left untreated or there is no proper rest post biceps tendinitis, the damage may progress to the point of biceps tendon tear.  Sudden sharp pain in the upper arm is the first sign of a biceps tendon tear.  Sometimes a popping or snapping sound can also be heard.

Internal Impingement:

Internal impingement is also referred to as “The Thrower’s Shoulder”.  Youngsters playing baseball are generally susceptible to this injury.  Internal impingement occurs during the “cocking” phase of throwing.  As the player puts the shoulder and arm back, the rotator cuff tendons get pinched between the glenoid labrum and the humeral head.  With time this may progress to a partial rotator cuff tendon tear, or it may harm the labrum.

Shoulder Instability:

It is a throwing injury wherein the instability of the shoulder sets in gradually.  Shoulder instability happens when the tissues in the shoulder are unable to keep the arm centered in the shoulder socket.  Ideally, the head of the humerus bone should normally rest in a shallow socket in the shoulder blade.  As a result of repetitive throwing, ligaments will stretch over time, making the shoulder head slip from the socket more easily.  Pain, numbness and decreased throwing velocity are the signs of this injury.

Glenohumeral Internal Rotation Deficit (GIRD):

Throwing at high speeds require extreme internal rotation causing the ligaments at the front of the shoulder to stretch and loosen, what generally happens then is that the soft tissues in the back of the shoulder tighten, leading to loss of internal rotation.

Scapular Rotation Dysfunction (SICK Scapula):

A throwing motion involves proper movement and rotation of the scapula over the chest wall.  The scapula relies on several muscles in the upper back to keep it in position to support healthy shoulder movement.

During throwing, repetitive use of scapular muscles creates changes in the muscles that affect the position of the scapula and increase the chances of shoulder injury.  Drooping of the affected shoulder coupled with pain at the front of the shoulder, near the collarbone is a clear symptom of scapular rotation dysfunction.

Treatment for throwing injuries of the shoulder often includes rehabilitation exercises designed specially for throwers.  Surgery is considered only as a last resort.

For enquiries related to sports injuries and their treatment options, send a message to www.BangaloreShoulderInstitute.com/contact

Q & A on Throwing Injuries of the Shoulder

1. How do throwing injuries of the shoulder occur?

For a sportsperson, especially those involved in throwing sports, there are great chances of throwing injuries to the shoulder. Due to the continuous stress on the shoulder caused by the throwing motion, the risk of injury is persistent. In sports like throwball, volleyball, baseball, and basketball, the stability of the shoulder is challenged. Injuries like tears, tendinitis, and impingement are some types of damage that can occur in your shoulder. The internal impingement may happen due to looseness in the structure that is at the front of the joint and also some stiffness at the back of the shoulder.

2. What are the symptoms of rotator cuff tear?

The rotator cuff is the group of muscles in the shoulder that help in the movement of arms. Its role is to keep the humerus in the shoulder blade socket. When the tendons pull away from the arm, injuries to the rotator cuff happen. This can be either a partial or complete tear. When there is an accident, it causes a sudden and immediate tear that leads to intense pain. The following symptoms may also be experienced:

• Pain while raising the hand
• Popping sounds when the arm is moved
• Severe shoulder pain when the arm is at rest
• Weakness of the shoulder leading to inability to lift things

2. What are SLAP tears?

When the cartilage in the inner part of the shoulder joint is facing a tear, it is called SLAP tears. They can be due to an injury or overuse of the shoulder. This is a kind of labral tear wherein the labrum is the rubbery cartilage present in the shoulder socket that reinforces the ball and socket joint. The superior labral tear from anterior to posterior (SLAP) occurs in the top section of the labrum. This is due to the repetitive action of the shoulder and is a common throwing injury of the shoulder.

3. What are the common throwing injuries to the shoulder?

SLAP tears, Biceps tendinitis, Biceps tendon tears, internal impingement, shoulder instability, Glenohumeral internal rotation deficit, and scapular rotation dysfunction. Biceps tendinitis causes inflammation of the upper biceps tendons. When this condition progresses without any treatment, it may lead to a biceps tendon tear. Internal impingement happens during the cocking phase of throwing. Shoulder instability occurs when the shoulder tissues are not able to keep the arm centered in the shoulder socket. When you begin to lose the normal rotational motion of the shoulder, it leads to scapular rotation dysfunction.

4. What is the treatment mechanism for throwing shoulder?

There are both surgical and non-surgical methods of treatment. The non-surgical methods include activity modification, applying ice, taking NSAIDs, physical therapy, cortisone injection, and change of position. The surgical methods are arthroscopy and open surgery. During rehabilitation, you will be advised to wear a sling to keep your arm from moving. Gentle stretches to regain range of motion will be advised after which exercises to strengthen the shoulder muscles and rotator cuff will be prescribed. It may take 2 to 4 months for recovery and more than 6 months to return to sports activities.

5. Why does my shoulder feel loose or unstable when I throw at high speed?

A feeling of looseness during throwing often suggests that the structures helping stabilise the shoulder are under excessive strain. Repeated overhead motion can gradually stretch the capsule and supporting ligaments around the joint, particularly in athletes who throw frequently. This can create subtle instability where the shoulder no longer stays centred smoothly during movement.

Patients commonly describe the sensation as the shoulder “slipping”, “dead arm”, or feeling unreliable during the late cocking phase of throwing. Even in the absence of a complete dislocation, ongoing instability can increase strain on the rotator cuff and labrum, gradually contributing to pain, weakened strength, and reduced precision in movement.

6. Can throwing injuries develop even if my throwing technique seems correct?

Yes. Good technique reduces risk, but it does not completely protect the shoulder from overuse. Throwing places extremely high rotational forces across the joint, especially during acceleration and follow-through. Even technically skilled athletes can develop overload injuries if they throw too often, increase intensity too quickly, or fail to recover properly between sessions.

Fatigue also plays a major role. As muscles tire, shoulder mechanics begin to change subtly, increasing stress on tendons, cartilage, and stabilising structures. This is why workload management, conditioning, and recovery are just as important as throwing technique itself.

7. Why does my throwing shoulder lose power before it becomes painful?

Loss of velocity or reduced throwing strength is often one of the earliest warning signs of shoulder dysfunction. Small changes within the rotator cuff, labrum, or shoulder stabilisers may affect performance before they create significant pain.

Many athletes first notice difficulty generating speed, reduced endurance, or poor control during longer sessions. The body often compensates for subtle shoulder weakness by altering movement patterns, which can temporarily mask pain while performance gradually declines. Persistent reduction in throwing ability should not be ignored, even if discomfort appears mild.

8. Is shoulder clicking during throwing always a sign of damage?

Not necessarily. Some painless clicking can occur naturally as tendons and soft tissues move around the joint. However, painful clicking, catching, or grinding during throwing deserves further assessment, especially if it is associated with weakness or instability.

Throwing athletes can develop labral tears, biceps tendon irritation, or internal impingement, all of which may create mechanical symptoms inside the joint. If the shoulder feels as though something is catching during movement, it is sensible to have the joint evaluated before the problem progresses further.

9. Why do throwing injuries often become worse gradually rather than suddenly?

Most throwing-related shoulder problems are repetitive stress injuries rather than single traumatic events. The shoulder experiences thousands of high-force movements over time, and the tissues gradually become overloaded faster than the body can repair them.

At first, symptoms may only appear after training or competition. As irritation increases, pain can begin earlier during activity and eventually continue into daily life. Because the progression is gradual, many athletes continue throwing through the discomfort without realising the injury is becoming more established.

10. Can poor shoulder blade control contribute to throwing injuries?

Yes, very commonly. Also referred to as the shoulder blade, the scapula serves as a key structural base that helps the shoulder move efficiently and in a controlled manner. If it does not move efficiently, extra stress is transferred to the rotator cuff and labrum during throwing.

Weakness or poor coordination of the muscles around the shoulder blade can alter throwing mechanics and reduce stability during overhead motion. Many rehabilitation programmes focus heavily on scapular control because improving shoulder blade function often reduces strain inside the joint itself.

11. Should young athletes continue throwing through mild shoulder pain?

No. Pain in a young throwing athlete should always be taken seriously. In children and teenagers, the growth plates are still developing and are more vulnerable to repetitive stress. Continuing to throw despite pain increases the risk of overuse injuries such as Little League Shoulder and other growth plate problems.

Young athletes often try to play through discomfort because they do not want to miss training or matches. Early rest and proper assessment are far safer than allowing a minor injury to progress into a longer-term problem that may affect development and future performance.

12. Why does my shoulder hurt more after throwing rather than during the activity itself?

Many throwing injuries become more noticeable once the shoulder cools down after activity. During throwing, adrenaline and muscle activation may temporarily mask discomfort. Once activity stops, inflammation and tissue irritation become more apparent.

Patients frequently describe aching at the front or back of the shoulder later in the evening or the following morning. Stiffness after rest can also suggest that the shoulder tissues are struggling to recover adequately from repetitive strain.

13. How important is rest in treating throwing-related shoulder pain?

Rest is extremely important, but it needs to be balanced properly. Completely ignoring symptoms and continuing full-intensity throwing often worsens tissue overload and delays recovery. At the same time, prolonged total inactivity can lead to weakness and stiffness.

Most athletes benefit from a structured rehabilitation plan that temporarily reduces throwing while maintaining flexibility, strength, and shoulder control. A gradual return-to-throwing programme is usually safer than immediately returning to competitive intensity once the pain settles.

14. Can throwing injuries affect athletes outside cricket and baseball?

Absolutely. Any sport involving repeated overhead movement can place similar stress on the shoulder. Volleyball, tennis, badminton, javelin, swimming, handball, and certain racquet sports all expose the joint to repetitive rotational forces.

The exact injury pattern may vary depending on the sport and technique involved, but the underlying issue is often the same: repeated overload of the soft tissues that stabilise the shoulder during high-speed movement.

15. When should a throwing athlete see a shoulder specialist?

A specialist assessment is sensible if pain keeps returning, throwing performance is declining, or the shoulder feels unstable during activity. Symptoms such as weakness, loss of range of motion, night pain, or persistent clicking should also be evaluated properly.

Early diagnosis often allows treatment to begin before more significant structural damage develops. Many throwing injuries respond very well to targeted rehabilitation when identified at the right stage.