Ask the Experts: How do I prevent ‘thrower’s shoulder?’

By Kristy Bleizeffer May 10, 2017

Orthopedic surgeon R. Lee Stowell, M.D., completed a fellowship in shoulder surgery.

For “overhead” athletes – think pitchers, tennis players, track and field athletes and volleyball players – shoulder pain can seriously dampen performance on the field and affect comfort off of it. 

Orthopedic surgeon Lee Stowell, M.D., of Advantage Orthopedics and Neurosurgery is fellowship trained in shoulder surgery from the CORE Institute in Phoenix. Here, he explains how to prevent "thrower's shoulder" and treatment options available.

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What is 'thrower’s shoulder?'

It is a type of overuse injury commonly seen in baseball pitchers and overhead athletes such as volleyball and tennis players. Repetitive stresses or “micro-trauma” can weaken the ligaments, muscles or tendons by causing persistent inflammation and pain.  Thrower’s shoulder also results from impingement of the tendons as they move through the shoulder.

What are the symptoms?

Symptoms include gradual pain over a period of time that persists longer than a normal muscle ache. Pain may or may not be associated with a single identifiable event. Patients will often notice the pain in the front and side of the shoulder and weakness and trouble with overhead activities. Symptoms can range from a sharp piercing pain to a constant dull ache. For high level competitive athletes, their main symptom will often be loss of pitch velocity.

How serious is it if left untreated?

Left untreated, the pain may persist for some time.  Further neglect could lead to more severe injury to the cartilage or tendons.

How is it treated?

Initial treatment consists of rest, ice, anti-inflammatories and a period of activity modification where the activities, movements and positions causing  pain are avoided for several weeks.  Other treatment includes a structured formal physical therapy program directed by the physician.

What should athletes and coaches do to prevent thrower’s shoulder?

Stressing proper conditioning and technique are the mainstays of prevention.  It is also important to allow an appropriate period for recovery to allow the body to heal prior to resuming the activity.

For younger athletes, following and respecting pitching guidelines for number of throws per game and week is critical.  Just as important is listening to a younger athlete who may be under the maximum pitch count but complains of pain or decreased velocity.  These are often harbingers of an impending problem.

Are surgical treatments available?

In certain circumstances surgery is indicated, but for the vast majority of patients, surgical intervention is reserved for those athletes who do not respond to more conservative measures or fail to improve with physical therapy and other modifications. Surgery also depends on the age of the patient, activities and expectations  

When should people see their doctor?

If symptoms do not improve with a trial of anti-inflammatories, rest, ice and activity modification, this may mean that something more severe is going on and they shoulder schedule an appointment.