In virtually all sports, the shoulders are called upon to perform feats of strength, speed, and endurance – feats for which they are not always well-suited.
For example, a baseball pitcher is required to throw a five-ounce baseball as hard as they can, as often as 300 times a day. Gymnasts support their whole body weights by their arms for hours on end. Football players endure the shock of repeated heavy impacts to their shoulders (as well as heads and necks) for their whole careers.
All other sports place inordinate physical demands onto the shoulders – which, thanks to its remarkable mobility, is an inherently unstable structure. This makes the shoulder far more vulnerable to injury than any other joint.
Some of the most common causes of shoulder pain in athletes are shoulder dislocations, acromioclavicular joint injuries, rotator cuff tendonitis and tears, labral and superior labral anteroposterior tears, fractures, and arthritis, as well as activity-specific injuries such as “thrower’s shoulder,” “swimmer’s shoulder” and “rugby shoulder,” among others.
Dislocated Shoulder
This is a disruption of the ball-and-socket in which the upper arm bone (ball) is removed from the socket. Dislocated shoulder is caused by a high-force acute injury such as a fall or overstretching of the arm overhead or behind the head. Chronic dislocations can occur in individuals who have had an acute dislocation or have general joint looseness in the shoulder. It is characterized by loss of the rounded appearance of the shoulder and severe pain. Immobilization is needed for 3-6 weeks directly following the injury. In severe cases, surgery might be needed to tighten the ligaments that hold the shoulder in place. Therapy for strengthening, pain, range of motion, and return to activity can be necessary depending on activity needs and patient goals.
Subluxation
Subluxation (sometimes called a partial dislocation) is similar to a dislocation and is usually triggered repeatedly by putting the hand behind the head. A subluxing shoulder can be caused by an acute incident or repeated strain from activities like throwing, swimming, or other high-speed overhead activities. It is characterized by the feeling of the joint slipping out of place, pain, and inability to perform normal overhead or throwing activities. Treatment can include strengthening of the rotator cuff to hold the joint in place, activity or movement modification by a therapist, or possibly surgery in severe cases.
Separated Shoulder
This is an injury to the joint between the shoulder blade and collarbone. Separated shoulder is caused by an acute injury, usually a fall directly onto the shoulder or on an outstretched hand. It is characterized by pain with shoulder movement away from the body and the appearance of a knot or lump on the top of the shoulder. No damage is done to the actual ball-and-socket part of the joint. Treatment is avoidance of pain-causing movements. Immobilization with a sling can be recommended in severe cases. Gradual return to activity is permissible as the pain subsides.
Labral Tear
The cartilage that surrounds the socket of the shoulder joint is called the labrum. A tear in the cartilage can result from being pulled on by the bicep tendon that attaches to it or by being pinched. It can also be injured from a dislocation. Diagnosis of a labral tear is usually done through an MRI or CT scan. Popping, pain with movements overhead, and a feeling of joint instability are common symptoms. The treatment is often surgery to repair the structure followed by rehabilitation for range of motion, strengthening of the surrounding structures, and activity and movement modifications.
Shoulder Fractures
Actual cracks and breaks in the scapula, or shoulder bone, are rare. Bones are very strong and can handle a surprising amount of trauma. In addition, the tough, flexible tissues surrounding the shoulder joint are in part evolved to protect the bone from breakage: the tendons, cartilage, and ligaments holding the bones to each other will generally stretch and break long before a bone can crack.
However, in high-velocity crashes and falls from high heights, the soft tissues cannot do their job of protecting the bones from breakage. Fractures in the shoulder are difficult to treat, due to the position of the bones making it hard to immobilize with hard casts in order to heal properly.
Thrower’s Shoulder
With repetitive overhead throwing, the front of the shoulder can stretch and the back can get tighter. This can cause abnormal gliding of the shoulder joint and a ‘catching’ of the labrum and rotator cuff, leading to rotator cuff tears and abnormal wear of the labrum.
Rugby Shoulder
The injuries are similar to those of the thrower’s shoulder but not as predictable. Special tests are required to diagnose and treat these specific injuries correctly.
Just because these sports can put you at risk for injuries doesn’t mean you should quit playing them or give up your career altogether. Work with one of our highly credentialed sports medicine physicians here at Greater Chesapeake Hand to Shoulder, so you can learn about proper movement technique and other strategies to help minimize your risk for injuries, and ultimately, reach your full athletic potential.
To arrange a consultation with one of our sports medicine physicians, contact our friendly staff at (410) 296-6232. You may also fill out our appointment request form, and we will promptly contact you to confirm your appointment.
