Shoulder Injuries in the Throwing Athletes and Treatment

Joel Abad
Professor Leslie Wolcott
ENC 1102
Shoulder Injuries in the Throwing Athletes and Treatment

A physical Therapist needs to know a lot of information of many different injuries and
know what treatment is best for every specific injury. Injuries can range from paralysis due to a
stroke or can be as simple as a sprained ankle. Because of this there is extensive amount of
research done on different injuries and what treatment is best for it. This literature review focuses
on shoulder injuries in the overhead throwing athlete and the treatments for these injuries. The
articles in this literature review range from 2004 to 2014 and are all written by professionals that
have done extensive amount of research on the subject they wrote about. The articles used in this
paper wasnt too difficult but that is because I have the resources given to me by my university.
The University of Central Florida pays to have subscriptions to academic databases which cost a
tremendous amount of money, without this resource I would have had to pay a lot of money in
order to be able to access these articles. Athletes in this article are mostly baseball pitchers since
they are the ones who often do the overhead throwing motion. The throwing motion itself puts
tremendous stress on the shoulder (Christoforetti JJ et al, 2005. Cummins CA et al, 2009.
Dimakopoulos P et al, 2006. Dodson CC et al, 2007. Greiwe RM et al, 2010. Heyworth BE et al,
2009. Radkowski CA et al, 2008. Ricchetti ET et al, 2010). Due to the stress of the throwing
motion studies show that the athletes shoulder range of motion decreases overtime (Christoforetti
JJ et al, 2005. Domes CM et al, 2012. Heyworth BE et al, 2009. Laughlin, Walter A. et al, 2014.
Radkowski CA et al, 2008. Zheng, N. et al, 2012). Some of these injuries are caused by improper
mechanics when throwing but when using proper mechanic, there is less stress applied to the

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shoulder (Dodson CC et al, 2007. Escamilla RF et al, 2009. Greiwe RM et al, 2010. Heyworth
BE et al, 2009. Laughlin, Walter A. et al, 2014. Nichols, Julia et al, 2012).
Treatment is a highly debated topic in the discourse and there is not one specific answer
as to when surgical or non-surgical treatment should be used but most agree that both treatments
are very effective and are successful most of the time (Dimakopoulos P et al, 2006. Dodson CC
et al, 2007. Domes CM et al, 2012. Fedoriw, W. W. et al, 2014. Greiwe RM et al, 2010.
Heyworth BE et al, 2009. Laughlin, Walter A. et al, 2014. Nagda, Sameer H. et al, 2011.
Ricchetti ET et al, 2010). Most physical therapists agree that surgical treatment should be used if
non-surgical treatment fails (Christoforetti JJ et al, 2005. Cummins CA et al, 2009. Dodson CC
et al, 2007. Domes CM et al, 2012. Nagda, Sameer H. et al, 2011). This literature review will
take you into the conversation that is taking place within the discourse community of physical
therapy about shoulder injuries in the throwing athlete and their treatments.
Shoulder Injuries
When it comes to baseball pitchers they all have a unique way of throwing to give the
ball movement but most do not use proper mechanics, using the proper mechanics to throw
overhead puts much less stress on the shoulder (Laughlin, Walter A. et al, 2014). When baseball
pitchers with proper mechanics were compared to pitchers that did not have proper mechanics
the amount of injuries was much less in those with proper mechanics, especially shoulder
injuries. This shows how proper mechanics could be a way to prevent baseball players from
having shoulder injuries. Even though many researchers said that the throwing motion itself puts
strain on the shoulder (Christoforetti JJ et al, 2005. Cummins CA et al, 2009. Dimakopoulos P et
al, 2006. Dodson CC et al, 2007. Greiwe RM et al, 2010. Heyworth BE et al, 2009. Radkowski
CA et al, 2008. Ricchetti ET et al, 2010). The amount of stress put on the shoulder with proper

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mechanics is much less than those without proper mechanics. The proper mechanics involve
using more power from the legs which helps put less stress on the arm rather than using just
your arm.
The throwing motion even done with proper mechanics or not does decrease the
shoulders range of motion over time (Christoforetti JJ et al, 2005. Domes CM et al, 2012.
Heyworth BE et al, 2009. Laughlin, Walter A. et al, 2014. Radkowski CA et al, 2008. Zheng, N.
et al, 2012). It has been proven by research when comparing a baseball pitchers throwing
shoulder to their non-throwing shoulder even with no history of injury, the range of motion is
decreased just by the stress the throwing motion puts on the shoulder (Zheng, N. et al, 2012).
Treatment
There are two major treatment options used to cure shoulder injuries in the overhead
throwing athlete, first is physical therapy rehabilitation and second is surgery. The controversy
lies when you ask which the best option is and when it should be used. Both surgical and nonsurgical treatment are both very effective and are successful most of the time (Dimakopoulos P et
al, 2006. Dodson CC et al, 2007. Domes CM et al, 2012. Fedoriw, W. W. et al, 2014. Greiwe RM
et al, 2010. Heyworth BE et al, 2009. Laughlin, Walter A. et al, 2014. Nagda, Sameer H. et al,
2011). Most shoulder injuries are treatable by rehabilitation but if that fails that is when surgical
treatment is used (Christoforetti JJ et al, 2005. Cummins CA et al, 2009. Dodson CC et al, 2007.
Domes CM et al, 2012. Nagda, Sameer H. et al, 2011). Non operative treatment is used for
restoring strength, flexibility, and neuromuscular control and if that fails that is when surgical
treatment is used. But no one is quite sure when to use operative treatment from the get go it is
usually the fall back plan.

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Conclusion
There has been plenty of research done on shoulder injuries in the overhead throwing
athlete and what causes these injuries, as well as the treatments used for these injuries. The
throwing motion itself causes tremendous amount of strain on the shoulder and without the
proper mechanics it can cause too much stress on the shoulder which will eventually develop
into an injury which will require medical treatment. Over time the throwing athlete will lose
range of motion in the shoulder just because of the strain put on it from the throwing motion.
Rehabilitation is a key treatment in treating shoulder injuries but if that fails then that is when
surgery is used to treat the injury. However, there has been an immense amount of research in
baseball pitcher but there is not much research done when it comes to other overhead throwing
athletes like football quarterbacks or cricket players.
Research can be done on football quarterbacks and cricket players and see if there is as
much stress put on the shoulder like the baseball pitcher. The way this research can be done is by
choosing at random pro football quarterbacks and pro cricket players and doing a research study
to see if there is strain on the shoulder from throwing as much as they do. Pro football
quarterbacks and cricket players would undergo tests to see if the shoulders range of motion in
their throwing arm is subpar to their non-throwing arm. As well other research can be done like
surveys showing the amount of shoulder injurie pro football quarterbacks and cricket players
have had in their lifetime and what caused these injuries. This will show if the throwing motion
these athletes do put strain on the shoulder like in baseball players. With this research done it
could show if the injuries talked about in the previous research is just for baseball pitchers or
applies to every overhead throwing athlete.

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Works Cited
Christoforetti JJ; Carroll RM. (2005). The Throwers Shoulder. Current Opinion in Orthopaedics.
(4), 246-51, DOI: N/A.
Cummins CA; Schneider DS. (2009). Peripheral nerve injuries in baseball players. Physical Medicine &
Rehabilitation Clinics of North America. (1), 175-93, DOI: 10.1016/j.pmr.2008.10.007.
Dimakopoulos P; Panagopoulos A; Syggelos SA; Panagiotopoulos E; Lambiris E. (2006). Double-loop
suture repair for acute acromioclavicular joint disruption. American Journal of Sports Medicine.
(7), 1112-9, DOI: N/A.
Dodson CC; Brockmeier SF; Altchek DW (2007). Partial-thickness rotator: cuff tears in throwing
athletes. Operative Techniques in Sports Medicine. (3), 124-31 DOI: N/A.
Domes CM; Petering RC; Chesnutt JC; Mirarchi A. (2012). Concurrent Little Leaguer's Elbow and
Shoulder in a 15-year-old Baseball Pitcher and Football Quarterback. Orthopedics. (1), 68, DOI:
10.3928/01477447-20111122-29.
Escamilla RF; Andrews JR (2009). Shoulder muscle recruitment patterns and related biomechanics
during upper extremity sports. Sports Medicine, (7), 569-90, DOI: N/A.
Fedoriw, W. W., Ramkumar, P., McCulloch, P. C., & Lintner, D. M. (2014). Return to Play After
Treatment of Superior Labral Tears in Professional Baseball Players. American Journal of Sports
Medicine, (5), 1155-60. DOI: 10.1177/0363546514528096.
Greiwe RM; Ahmad CS. (2010). Management of the throwing shoulder: cuff, labrum and internal
impingement. Orthopedic Clinics of North America. (3), 309-23, DOI:
10.1016/j.ocl.2010.03.001.
Heyworth BE; Williams RJ III (2009). Internal impingement of the shoulder. American Journal of Sports
Medicine (5), 1024-37, DOI: 10.1177/0363546508324966.
Laughlin, Walter A.; Fleisig, Glenn S.; Scillia, Anthony J.; Aune, Kyle T.; Cain, E. Lyle; Dugas, Jeffrey
R. (2014). Deficiencies in Pitching Biomechanics in Baseball Players With a History of Superior
Labrum Anterior-Posterior Repair. American Journal of Sports Medicine. (12), 2837-41. DOI:
10.1177/0363546514552183.
Nagda, Sameer H.; Cohen, Steven B.; Noonan, Thomas J.; Raasch, William G.; Ciccotti, Michael G.;
Yocum, Lewis A. (2011). Management and Outcomes of Latissimus Dorsi and Teres Major
Injuries in Professional Baseball Pitchers. American Journal of Sports Medicine, (10), 2181-6.
DOI: 10.1177/0363546511422219.
Nichols, Julia; Calver, Stuart; Chester, Rachel. (2012). Are stretches effective in the prevention and
treatment of glenohumeral internal rotation deficit? Physical Therapy Reviews. (5), 261-70, DOI:
10.1179/1743288X12Y.0000000021.
Radkowski CA; Chhabra A; Baker CL III; Tejwani SG; Bradley JP. (2008). Arthroscopic capsulolabral
repair for posterior shoulder instability in throwing athletes compared with nonthrowing athletes.
American Journal of Sports Medicine. (4), 693-9, DOI: N/A.

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Ricchetti ET; Weidner Z; Lawrence JTR; Sennett BJ; Huffman GR. (2010). Glenoid labral repair in
Major League Baseball pitchers. International Journal of Sports Medicine. (4), 265-70, DOI:
10.1055/s-0030-1247596.
Zheng, N.; Eaton, K. (2012). Shoulder Rotational Properties of Throwing Athletes. International Journal
of Sports Medicine. (6), 463-8, DOI: 10.1055/s-0031-1295440.