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 annotated bibliography
provides information on shoulder injuries in the overhead throwing athlete and the treatment
used for these injuries and what treatment worked best. Athletes in this article are mostly
baseball pitchers since they are the ones who often do the overhead throwing motion. The
overhead throwing motion can be fatal to ones shoulder, because without the proper mechanics
there is a tremendous amount of strain put on the shoulder which cause shoulder injuries.
The articles in this annotated bibliography 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. This annotated bibliography is
geared toward physical therapists and even athletes with shoulder injuries, but due to some high
level vocabulary that only those who are in the discourse community of physical therapy would
be able to understand it leans more toward physical therapists.

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Christoforetti JJ; Carroll RM. (2005). The Throwers Shoulder. Current Opinion in Orthopaedics.
(4), 246-51, DOI: N/A. The authors in this article are part of the department of
Orthpaedic Surgery in Georgtown University Hospital. They have years of experience
and are very skilled in their professional fields. This article is about modern research
studies about pushing an overhead throwing athletes shoulder to its limit, it talks about
what the shoulder can withstand and how pitching can put an immense amount of
pressure on the shoulder if proper mechanics arent used when pitching. The article
shows a pitchers shoulder range of motion is decreased after pitching for many years.
Nonoperative management is used as treatment and operative treatment are less clear and
should be reserved for refractory conditions according to this article. This article ties into
my conversation because it talks about how shoulder injuries are prone to overhead
throwing athletes unless they have proper mechanics. It also states when operative and
nonoperative treatment should be utilized as treatment for shoulder injuries.

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. The authors in this article are orthopedics and have done an
extensive amount of research on the stress the throwing motion does to an arm. In this
article the authors study the nerve injuries the throwing motion causes in an athletes
shoulder as well as the treatments. Due to the stress the throwing motion causes on the
arm, overhead throwing athletes are prone to nerve damages in their shoulder like
suprascapular neuropathy, quadrilateral space syndrome, and cubital tunnel syndrome.
The treatment for these injuries can be both nonoperative and operative but operating is

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usually done if nonoperative treatment fails. This article ties in to my conversation

because it shows how overhead throwing athletes are prone to nerve injuries just by the
throwing motion as well it speaks about how this injury is treated.

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. The authors in this article are highly
experienced in the field of arm injuries in overhead throwing athletes and have done an
extensive amount of research when it comes to injuries in the overhead throwing athlete.
This article focuses on a specific injury in the shoulder called acute acromioclavicular
joint disruption. The article is about deciding what treatment is the best treatment for this
injury. This injury is caused by overuse of the throwing arm and putting stress on the arm
while doing the throwing motion. The best decided treatment is surgery but the article
focuses on which surgery is best for this treatment. They tested the surgery double-loop
suture repair and it worked best out of the other procedures that were used before. This
article ties in to my conversation because it is about the surgical treatment of a shoulder
injury in overhead throwing athletes and it states the best possible treatment for this
particular injury.

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. The authors in
this articles are well experienced in shoulder injuries and surgeries and work for the

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hospital for special surgery in New York, NY. This article focuses on the injury many
overhead athletes acquire due to the motion of throwing. Rotator cuff tears, which is
exactly what you think it is, a tear in the rotator cuff due to the tremendous force and
torque the throwing motion creates on the shoulder. The authors speak about the best
methods of treatment for this common injury which they decided depends on how bad the
tear is. If the tear is deep surgery is the best treatment option since rehabilitation will not
work and the pain will not decrease. On a minor tear Physical Therapy is the best
treatment option and will work just as well as surgery. This article is important to my
conversation because it helps physical therapists decide what is the best form of treatment
when a patient comes in with this injury, after reading this article they now the best
treatment depends on how bad the tear in the rotator cuff is.

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. The authors in this article are very skilled
and well trained in their field, they have a lot of experience when it comes to arm injuries
and how to rehabilitate them. This article is more of a story than anything which talks
about a young 15 year old boy who is a baseball pitcher and a football quarterback. He
developed little league elbow and little league shoulder and there is always controversy
about what is the best treatment method when it comes to injuries like little league
shoulder. Some physicians believe it is best to do an operative treatment rather than just
rehabilitation while others say rehabilitation works just as well as surgery. They boy had
surgery in his elbow and nonoperative treatment on the shoulder. Two year follow up

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radiographs showed the boy had fully healed on both the shoulder and elbow and is back
to his full potential. This article relates to my conversation because it shows how both
treatment methods are effective in curing an injury and even though the surgery was
performed on the elbow it is still relatable since some physicians arent sure what is the
best form of treatment for shoulder injuries either, whether its operative or nonoperative.

Escamilla RF; Andrews JR (2009). Shoulder muscle recruitment patterns and related
biomechanics during upper extremity sports. Sports Medicine, (7), 569-90, DOI: N/A.
These authors have done extensive amount of research when it comes to shoulder injuries
in overhead throwing athletes, they are from Andrews-Paulos Research and Education
Institute, and have published multiple research studies. These authors wrote this article to
show how active shoulder muscles are during upper extremity sports, this is helpful to
physicians and physical therapist to provide appropriate treatment for those athletes when
injured. In this study they used baseball pitchers and measured the activity of a certain
muscle when throwing a baseball. They found out that the most activity is done during
the arm cocking phase when throwing a baseball which is when the pitcher is loading
back about to release the ball. This is that phase when most injuries occur in baseball
players. This ties in to my conversation because this article identified when overhead
throwing athletes are most likely to get injured while throwing a ball, knowing this
allows for specific treatment to be performed.

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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. Professionals in the
fields of physical therapy and sports medicine, the American Journal of Sports Medicine
wrote an article about baseball players undergoing non-surgical treatment to return on the
field after a shoulder injury and play to their full potential. The authors conducted a study
on athletes that had superior labrum anterior-posterior tears, the solution to this problem
is usually surgery but some players even after surgery never return to the level they once
were. Sixty eight athletes with superior labrum anterior-posterior tears underwent nonsurgical rehabilitation and results showed 40% of pitchers and 39% of position players
returned to play and a little less than that returned to prior performance. So the hypothesis
was correct and non-surgical treatment can be a solution when you have superior labrum
anterior-posterior tears. This article is important to my discussion of shoulder injuries in
throwing athletes and treatments because this shows how non-surgical rehabilitation is
beneficial and surgery is not the only option when it comes to shoulder treatment.

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. The authors in this article are specialized in shoulder, elbow,
and sports medicine. They have done extensive amount of research on arm injuries for
Columbia University. This article explains how the throwing motion in baseball pitchers
put a tremendous amount of stress on the shoulder if the legs and trunks of the body are
not used to aid the arm in throwing. If you throw with just your arm that when there is

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a tremendous amount of stress on the shoulder and even the elbow. The article explains
what kinds of treatments are needed and when theyre needed. For example, nonoperative
treatment is used for restring strength, flexibility, and neuromuscular control. Operative
treatment is used when nonoperative treatment fails. This article ties in to my
conversation because it explain why most shoulder injuries in overhead throwing athletes
occur and what form of treatment is needed. It also explains that baseball pitchers must
learn proper mechanics when pitching to avoid shoulder injuries.

Heyworth BE; Williams RJ III (2009). Internal impingement of the shoulder. American Journal
of Sports Medicine (5), 1024-37, DOI: 10.1177/0363546508324966. The authors in this
article are professionals in their field and have many years of experience that have
accumulated skill about shoulder injuries in overhead throwing athletes. This article is
about internal impingement of the shoulder is a pathologic condition characterized by
excessive or repetitive contact of the greater tuberosity of the humeral head with the
posterosuperior aspect of the glenoid when the arm is abducted and externally rotated.
This usually happens to pitchers due to the throwing motion and it explains how surgical
and nonsurgical treatment can be made to treat this injury, surgical treatment is usually
done if non-surgical treatment fails. This article ties in to my conversation because it
shows the injury that overhead throwing athletes are prone to and talks about the
treatment methods that are done in order to heal this injury.

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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. The authors in this article
are very skilled in their professional field and have done extensive research in their field
as well. This article involves baseball pitchers that have gone through Superior Labrum
Anterior-Posterior (SLAP) repair. A SLAP tear is when there is a tear in the bicep tendon
connected to a ring of cartilage in the shoulder. This injury is common in overhead
throwing athletes. The article focuses on the difference between the mechanics of pitchers
that have never had a SLAP tear or repair compared to the pitchers that have gone
through the SLAP repair. What they discovered through this study is that a SLAP repaired
shoulders range of motion is less than a regular shoulder and this affects the mechanics
of a pitcher. What they also discovered is that pitchers with SLAP repair had more of a
forward trunk tilt when pitching compared to the pitchers with no history of injury which
this also strains the shoulder. This article relates to my conversation because this shoulder
injury in overhead athletes affects the athlete even after they have been treated and gone
through rehabilitation, by doing this study now pitchers know they must work extra hard
to get their full range of motion back in their shoulder and focus on having a less forward
trunk tilt when pitching.

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,

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(10), 2181-6. DOI: 10.1177/0363546511422219. Latissimus dorsi and teres major

injuries are rare in professional baseball pitchers so there is not much data about it and
what treatment is most effective. In this article the authors got 16 professional athletes
that were diagnosed and treated for latissimus dorsi and teres major injuries between the
years of 2002 and 2008. The authors results were that these injuries occur mostly to
pitchers and with just rest and non-operative treatment and rehabilitation was enough to
get the pitcher back to their full potential and allowed to pitchers go back and compete in
the professional level. This article relates to my discussion because it is about a shoulder
injury that occurs to pitchers and not much is known about it so after doing research and
testing rehabilitation methods they were able to figure out what is the best treatment for
this injury.

Neuman, Brian J.; Boisvert, C. Brittany; Reiter, Brian; Lawson, Kevin; Ciccotti, Michael G.;
Cohen, Steven B. (2011). Results of Arthroscopic Repair of Type II Superior Labral
Anterior Posterior Lesions in Overhead Athletes: Assessment of Return to Preinjury
Playing Level and Satisfaction. American Journal of Sports Medicine. (9), 1883-8, DOI:
10.1177/0363546511412317. Professionals in the field of physical therapy and sports
science published a research report in the journal The American Journal of Sports
Medicine. The authors did a research that checked up on athletes that have undergone
surgical treatment of superior labral anterior posterior many years prior. They did this to
show how effective the procedure is not just months after the surgery but years after.
Results showed that 93.3% of the athletes were satisfied and are still playing the sport to
their full potential with no problems. This article is important to my discussion of

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shoulder injuries in throwing athletes and treatments because it shows how this certain
treatment is very effective and reliable.

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. Everyone has heard to stretch before
you do physical activity so you do not hurt yourself. In this article the authors test out that
hypothesis. They want to see if stretching helps reduce shoulder injuries and
glenohumeral internal rotation deficit (GRID). How they did this by testing the
effectiveness of certain stretches on the shoulder of a person. What they concluded was
that certain stretches benefit your shoulder more than others and stretching every day
rather than before the physical activity benefits more. They realized that stretching does
not have that much effect in reducing GRID and shoulder pain. This article relates to my
discussion because it talks about how you can prevent shoulder pain and shoulder injuries
in overhead throwing athletes even though stretching doesnt benefit your shoulder that
much the article still benefits in the study to find ways that do prevent shoulder injuries.

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. The
authors in this article are professionals in their fields and have done extensive amount of
research in their field as well, they are from the University of Pittsburgh. In this research

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study the authors treated 98 athletes with shoulder injuries with Arthroscopic
Capsulolabral Repair a surgical procedure and were then evaluated in range of motion,
strength, pain, and function between throwers and non-throwers. 27 months after the
surgery the athletes were evaluated and the results showed that there were no differences
in stability, range of motion, strength, pain and function between throwers and nonthrowers. This article ties in to my conversation because it shows Arthroscopic
Capsulolabral Repair is an effective treatment option to certain shoulder repairs like
unidirectional posterior shoulder instability and after 27 months the athlete will be back
to its full potential as it was before the injury.

Ranson C; Gregory PL. (2008). Shoulder injury in professional cricketers. Physical Therapy in
Sport. (1), 34-9, DOI: N/A. The authors in this article are from Loughborough University
and have many years of experience in physical therapy and treating sports injuries. This
article is about shoulder injuries in professional cricket players. Most cricket players
report shoulder injuries in their lives while paying cricket and results show that most play
without getting treated for it according to a survey that was given. They just go to
positions that dont require much overhead throwing. This article ties in to my
conversation because it is about overhead throwing athletes and the injuries that cricket
players go through and the treatment they go through which is simply not getting treated
for it, well at least most cricket payers dont.

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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. Major league baseball pitchers are prone to arm injuries
due to the motion of throwing a baseball. Many of the injuries require baseball players to
undergo surgery. These authors did research on labral repair in major league pitchers
which is a shoulder injury that results from the throwing motion. The authors wanted to
see the success rate of the surgery that is needed because of this injury and they wanted to
see the performance of the pitchers after the surgery. 72.5% of the players that underwent
the surgery returned to the major league with no significant change in performance. The
authors also noticed that starting pitchers were more likely to get this injury than any
other player on the field. This article is important to my discussion because it explains
how this shoulder injury is not a big deal compared to others. This surgery has a very
high return rate and players usually return with no change in performance.

Wright RW; Paletta GA Jr. (2004). Prevalence of the Bennett lesion of the shoulder in major
league pitchers. American Journal of Sports Medicine. (1), 121-4, DOI: N/A. The authors
in this article have done extensive research on this topic for Washington University, they
are well experienced on this topic. The authors conducted a research to see if the Bennett
lesion is more common than one thought. A Bennett lesion is a mineralization of the
posterior inferior glenoid noted in overhead throwing athletes. 55 asymptomatic pitchers
were chosen and underwent routine radiographic screening, the results showed that 12
pitchers had Bennett lesion with no sign of symptom or pain. There were significant
difference between the pitchers that had the lesion and the pitchers that didnt as in

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amount of innings pitched or how long they have pitched for. This article showed that the
Bennett lesion is relatively common within baseball pitchers and the lesion doesnt really
have symptoms but it should get treated because it can get worse and then damage the
shoulder. This tied in to my conversation because it showed a shoulder injury in overhead
athletes that is relatively common and doesnt always correlate with pain in the shoulder
but it should get treated.

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. Different athletes
have different throwing motions, some throwing motions can affect your arm and even
injure your arm. In this article the authors got 96 baseball pitchers and examined both of
their shoulders to see the difference between their throwing arm and their non-throwing
arm. The authors made a custom-made wireless device was developed to record the force
applied and the rotational position of the upper arm during shoulder rotational test The
subject lay down on his back on an examination table. The shoulder under examination
abducted about 90 in the coronal plane. The examiner attached the wireless device to the
subjects distal end of the forearm. The shoulder scapular was stabilized manually during
test by applying a posterior force against the subjects coracoids process and clavicle. The
wireless system was calibrated and validated with errors less than 1.5 for orientation and
1 N for force measurement. The arm orientation and force applied during testing were
recorded at 100Hz using a Bluetooth wireless connection. An audio feedback was set
when the applied force reached 40 N. Both the force applied and forearm orientation
were displayed in real-time on a computer screen. The results of this showed that overall

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the throwing arm had less capability then the non-throwing arm. Results also showed that
abnormal shoulder rotational properties may be related to throwing arm injuries. This
article is important to my discussion because it shows how just the throwing motion can
affect the shoulder of an athlete. The throwing motion affects the shoulder in a negative
way and the shoulder of the throwing arm has less capability compared to the throwing
arm.