Throwing related Shoulder pain in Sports men

After the just concluded cricket Test series between India and England one saw the shoulder injury of Sachin Tendulkar surface. He has rushed off to England and has undergone arthroscopic shoulder surgery. He will be out of the game for eight weeks and only return for the West Indies tour later this summer. One can also remember that Anil Kumble, Rahul Dravid, & Srinath have suffered shoulder injuries in the past and returned to the game after successful treatment. Shoulder injuries can plague the career of cricketers and if not treated can cut short their lucrative careers. Cricketers are at risk as Cricket is a throwing game where one chucks the ball either as a bowler or a fielder. In this article, I will throw some light on throwing injuries.

Two problems can affect the shoulder in sportsmen who perform repeated acts of raising the arm overhead and swinging it in the course of a throw. These are called impingement and instability.

The shoulder joint is formed by the union of the round upper end of the humerus at the socket part by the scapula. It is a very mobile joint as the socket is shallow. Connective tissue restraints chiefly in the front confer additional stability. When the capsule or its attachments are injured instability results. In instability when the soft tissue restraints are loose the ball of the humerus can slide to the front, down wards or to the back in an abnormal fashion.

Impingement results from the abnormal upward gliding movement of the humerus and rubbing on the undersurface of the Acromion. This initiates or aggravates the damage to the rotator cuff. The rotator cuff is a group of tendons which act to actively stabilize the shoulder when the arm is lifted up.

Both conditions can cause pain and result in confusion to the patient and his doctor.

Slow motion analysis of the throw- Each sport has its own basic pattern, different sports have much in common. The performance of overhead sporting activities begins with a preparatory phase to position the arm. Subsequently the arm is cocked to provide a tense, highly forceful unit ready for an accelerated release. The arm accelerates through the throw and after release of the ball, muscles act to decelerate the limb, to reduce the residual force and to avoid injury. The throw in a typical baseball pitch is divided into five stages.

1) Stage 1- Wind up or preparation phase, which ends when the ball leaves the gloved hand. In cricket the equivalent is the transfer of the ball from the non dominant to the throwing arm.
2) Stage 2 or early cocking- when the shoulder is lifted sideways (abducted) and rotated outwards and ends with the forward foot contacting the ground.
3) Stage 3, late cocking phase This continues until maximum external rotation at the shoulder is obtained.
4) Stage 4-The acceleration phase that starts with internal rotation of the humerus and ends with ball release from the throwing hand.
5) Stage 5- Follow through phase that starts with ball release and that ends when all movement is complete.

This slow motion analysis is necessary to pinpoint the exact phase at which the subject experiences pain. Electromyography studies have demonstrated that in each of these phases there is selective muscle action. Athletes can have selective weakness of muscles, rather than generalized muscle impairment. A rehabilitation programme should concentrate on developing the weaker muscles.

I take a detailed history to recall the exact moment when pain is felt. After a thorough clinical examination, I can conclude often which muscle or tendon is injured or weak and what needs to be done. A clear distinction has to be made between instability and impingement, although both may co exist and one may lead to the other. MRI scans may confirm the clinical finding. An examination under anesthesia plus a shoulder arthroscopy may confirm the diagnosis. Shoulder arthroscopy permits the surgeon to visualize the damage inside the shoulder joint and remedy it either arthroscopically or by open methods.

Strengthening of the selected muscles after surgery may make a difference to the faster rehabilitation.

The author is an Orthopedic shoulder surgeon in Chennai at the Knee and Shoulder clinic and can be contacted on mobile 00 91 9282165002. His website www.shoulderindia.com provides more information on other shoulder injuries in sportspersons.