THROWING SHOULDER

THROWING SHOULDER

As the name suggests, it include injuries in overhead athletes like Baseball pitchers, volleyball players, swimmers, tennis players, javelin throwers.

Some injuries in overhead athletes

• Rotator cuff disorders

· Instability

· SLAP lesions

• Bennett lesion

SYMPTOMS:

• SHOULDER PAIN, loss of throwing speed and distance, lack of control. Others can be tingling, numbness, discoloration.
• Age of patient will give us a clue:      

• young athlete-  most likely physeal injury, labral pathology, instability
• Older athelete- usually rotator cuff pathology

DIAGNOSIS:

• CLINICAL: Local examination and some specific tests like Sulcus test, Clunk test, apprehension test, O’Brien’s test etc.
• IMAGING:

• X Rays:  Has limited role.
• CT scan: Although less frequent, used to identify and quantify bony lesions.
• MRI Scans: Investigation of Choice. Contrast enhanced MR Arthrogram shoulder is a very useful adjunct to visualise small hidden lesions.

 

TREATMENT:

• NON-SURGICAL: Rest to affected limb, splintage of limb (acute injury), NSAIDs/ intra- articular steroids to reduce inflammation.
• SURGICAL: High-grade injuries and those not responding to medical management will need surgery. Arthroscopic surgery is treatment of choice. 

REHABILITATION:

• Acute phase:

• AIM: Reduce pain and inflammation. Improve Flexibility, dynamic stability, strength (closed chain exercises only)

• Intermediate phase:

• Prerequisite: Minimal pain and inflammation. Near normal ROM, baseline muscle strength without easy fatigability.
• AIM: Maintain flexibility and stability. Improve muscle strength (start open chain exercises). Restore muscular balancing.

• Strengthening Phase:

• Prerequisite: Full ROM. Painless. Full strength without fatigue.
• AIM: Improve strength, power, endurance, neuro muscular control and initiation of single hand throws.

• Return to sports:

• AIM: Induction to throwing program. Shorter distance-low intensity to full distance- maximum intensity.