Throwing Injuries
There are some injuries that may occur in a thrower’s shoulder and elbow that simply do not occur in other shoulder and elbows. The constant, repetitive overhead throwing motion imparts high, outward, extension loads to the athlete’s shoulder and elbow. This often leads to either chronic or acute injury or a progressive structural change.
Common injuries that are usually encountered in the throwing elbow include ulnar neuritis, ulnar collateral ligament tears, flexor-pronator muscle strain or tendonitis, valgus extension overload syndrome with olecranon osteophytes, medial epicondyle apophysitis or avulsion, olecranon stress fractures, osteochondritis dissecans of the capitellum, and loose bodies. Understanding throwing biomechanics, along with a thorough knowledge of the anatomy and function of the shoulder and elbow is imperative to properly diagnose and treat the throwing athlete. Significant advantages in recent arthroscopic surgical techniques and ligament reconstruction have markedly improved the prognosis for a healthy return to competition for the extremely motivated athlete.
Likewise, common throwing shoulder injuries include labral tears, bursitis, tendonitis, rotator cuff tears,biceps tendon injuries, capsular contractures, and shoulder blade (scapula) dyskinesis (abnormal movement) or true winging. A common condition in which throwing athletes develop loss of internal rotation from scarring of the joint capsule, scapula dyskinesis, labral tears, and rotator cuff tears is known as GIRD or glenohumeral internal rotation deficit. It is the most common condition affecting the throwing shoulder.
The shoulder and elbow are inextricably intertwined with each other and to the joints and muscles of the trunk and lower extremities(hip, back, knee, ankle). Therefore, in order to maintain painfree throwing, potential causes of altered throwing kinematics must be prevented with a balanced training program and treated appropriately when identified.
It must be pointed out; however, that continuation of overhead throwing most often results in subsequent injury and symptom recurrence in the competitive athlete.
Treatment
Most treatment for injuries involving the throwing shoulder and elbow are nonoperative. When this fails, surgery may be indicated. However, returning to throwing at the same level requires not only successful surgery but a lengthy (12 months) and specific rehabilitation program.
Nonoperative treatment is usually prescribed if the injury is:
*A direct result of overuse.
*The result of a sudden (acute) injury that does not have severe damage in the shoulder or elbow.
In most cases, injuries to the throwing shoulder and elbow will respond to ice, rest, a program of rehabilitation exercises, splints, and pain medication. This type of injury usually requires approximately six to twelve months to heal completely.
If the patient does not respond to conservative treatment, surgery is considered when:
*Large tears in the tendon or other extreme damage to the elbow is the result of a sudden (acute) injury.
*The injury is the direct result of chronic overuse, and after six to twelve months of rehabilitation and tendon rest hasn’t relieved elbow pain.
*Elbow pain continues despite other treatments, such as acupuncture or corticosteroid shots.
*Loss of internal rotation of the shoulder has not responded to stretching exercises
*Shoulder pain has not responded to stretching and strengthening exercises, rest, or injections of cortisone
*MRI reveals labral or rotator cuff tears
The type of surgery performed depends on the pathology. However, commonly performed procedures in the throwing elbow include medial collateral ligament reconstruction (Tommy John procedure) and arthroscopic debridement. Commonly performed shoulder procedures include arthroscopic posterior capsular contracture release, labral repair, and rotator cuff repair.
Complete recovery of surgery varies with each patient and with the pathology encountered. Most individuals are capable of returning to their daily routine within a period of approximately three to six weeks. It is important to warn the patient that the initial relief from arm pain does not allow them to engage in heavy activity or sports for at least four or more months. Return to throwing competition can require 12-15 months. Tendons take a long time to heal completely. Subjecting the tendons to strong forces may cause significant delay in healing or cause permanent damage, or cause significant damage. |
