par Lynn Shapiro
, Writer | April 08, 2009
The thrower will often complain of diffuse shoulder pain aggravated by overhead activity and will notice weakness and decreased velocity. Night pain down the arm to the elbow is also common. Conditioning and proper throwing techniques are critical in preventing rotator cuff injury. Preventing this injury is especially important as rotator cuff repair surgery has been disappointing for elite throwers.
Scapular (shoulder blade) pain is the result of abnormal scapular movement, malposition and snapping of bursal tissue around the scapula. The scapula provides a stable base for muscles in the shoulder, thus abnormal positioning and movement can force the arm into strenuous positions and lead to decreased motion and rotation or "dead arm" syndrome. Muscle strengthening and conditioning are necessary to keep the scapula in place for an effective overhead throw. Initial treatment for scapular pain is rest, pain relievers, and nonsterodial anti-inflammatory drugs.
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Impingement results from pressure on the rotator cuff from part of the shoulder blade as the arm is lifted. Pain during the late cocking and early acceleration phases of throwing is most common. Impingement can cause local swelling and tenderness in the front of the shoulder, and pain and stiffness may be felt when the arm is lifted or lowered from an elevated position.
Conservative treatment for impingement includes oral, nonsteroidal anti-inflammatory medication, stretching to improve range of motion, injections of local anesthetic and a cortisone preparation to the affected area and rest. Rotator cuff and shoulder blade strengthening and conditioning will help shorten recovery time. Difficult cases may require surgery to remove the impingement in order to create more space for the rotator cuff, allowing for freer movement to lift the arm without pain.
Neurovascular disorders occur when nerves or blood vessels are being compressed, blocked or pinched causing fatigue, loss of velocity, vague shoulder pain, a sense of heaviness, achiness or cramping in the arm. Numbness, tingling, weakness of grip and loss of manual dexterity may also be symptoms experienced after the onset of throwing. Although rare, neurovascular disorders cause significant damage and recovery may be difficult. Successful non-operative treatment methods include rest and thrombolytic and anticoagulation injections used to diffuse blood clots. However, 30 percent of throwers will not respond to conservative measures and will require surgical intervention.