Thrower's shoulder / athlete's shoulder

Acute care & follow-up treatment

How does a thrower's shoulder / athlete's shoulder develop?

Overhead and throwing sports (e.g. volleyball, baseball, tennis, etc.) are associated with a high load on the shoulder joint due to the specific movement pattern. An effective throwing technique requires the arm to be raised sideways and an extreme external rotation of the shoulder joint, which results in permanent overloading of the capsular and muscular structures.

In the case of prolonged stress intensities of this kind, over several years, the patient benefits from increased external rotation with a simultaneous reduction in internal rotation capacity. This results in overstretching of the anterior shoulder capsule and a shrunken posterior capsule. This is the full picture of the so-called GIRD syndrome (Glenohumeral Internal Rotation Deficit).

If training continues despite the warning signs, pain occurs and this is referred to as “dead arm syndrome” (pain when throwing, insecurity, reduced throwing power and speed). This is now referred to as “thrower’s shoulder” or “athlete’s shoulder”. In tennis and volleyball players, the pain usually occurs during the service, i.e. when the racket touches the ball or the hand touches the volleyball.

Possible injuries are:

The internal "impingement" in the area of the posterior-superior joint socket and a possible detachment of the biceps tendon anchor (SLAP).
Partial tears of the rotator cuff, "PASTA lesion" (partial articular supraspinatus tendon avulsion), damage to the anchor of the long biceps tendon, SLAP lesion (=superior labrum from anterior to posterior) i.e. on the upper edge of the glenoid cavity.
Overloading of the biceps tendon with resulting biceps tendon syndrome. This is a type of tendon sheath inflammation in the anterior part of the shoulder

How is a thrower's shoulder / athlete's shoulder treated?

In the early phase, the throwing shoulder can be treated very well with stretching exercises for the posterior shoulder capsule and strengthening exercises for the external rotators, which are usually less pronounced.
It is also important to train the hollowing out movement, or service movement , in a sport-specific manner in order to prevent structural damage as the condition progresses.

At an advanced stage, the patient is usually confronted with structural wear and tear. If the level of suffering increases and physiotherapy does not have the usual effect, the only option is often arthroscopy (shoulder arthroscopy)

What is done during an operation?

This essentially depends on the existing damage to the inside of the shoulder:

SLAP lesion: Depending on the extent of the injury, the biceps anchor is either smoothed or fixed back in its original position with a suture.
Traumatic rotator cuff tears in young athletes and in the under-40 age group require prompt surgical treatment.
Partial tears of the rotator cuff, PASTA lesions can either be smoothed or sutured with good results.
If there is an additional Shoulder instability, with detachment of the anterior labrum, a capsular tightening is performed at the bottom front. This usually involves 2-3 endoscopic (=keyhole technique) sutures to reduce the size of the enlarged anterior, lower shoulder capsule.