Orthopedics Shoulder & Elbow Shoulder Pain When Throwing a Ball By Jonathan Cluett, MD Jonathan Cluett, MD LinkedIn Twitter Jonathan Cluett, MD, is a board-certified orthopedic surgeon with subspecialty training in sports medicine and arthroscopic surgery. Learn about our editorial process Updated on January 19, 2023 Medically reviewed by Eva Umoh Asomugha, M.D. Medically reviewed by Eva Umoh Asomugha, M.D. LinkedIn Eva Umoh Asomugha, MD, is a board-certified orthopedic surgeon who specializes in all conditions involving the foot and ankle region. She is based in northern Virginia. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Motion of Throwing Causes of Pain Symptoms Diagnosis Treatment Shoulder pain when throwing a ball is not so surprising when you consider the complexity of the shoulder joint and what it takes to perform that motion. To move your shoulder joint, the muscles, tendons, ligaments, and bones all have to move in a synchronized and stable pattern. Because of this, subtle abnormalities can lead to shoulder pain and discomfort when you are throwing or afterward. This article reviews the mechanics of the throwing motion and reasons it may cause shoulder pain. It also discusses symptoms of a shoulder problem, what's involved in diagnosis, and how it can be treated. Jose Luis Pelaez / Getty Images The Motion of Throwing The throwing motion is characterized by four distinct phases: Wind-upCockingAccelerationFollow-through For effective throwing mechanics, the rotator cuff and other shoulder muscles must sequentially guide these movements. The labrum must stabilize the ball in the socket of the shoulder. The shoulder blade rotation must coordinate with the arm to ensure mobility. The throwing motion causes very high torque and acceleration forces that act on the shoulder joint and the muscles, ligaments, and tendons that surround the joint. Causes of Pain While Throwing Pain while throwing may come from the: Shoulder bladeShoulder joint (cartilage and labrum)Rotator cuff muscles and tendonsNerves that control the function of the muscles The shoulder blade is attached to the chest wall with ligaments, muscles, and tendons. The various muscles and tendons that control the movement of the shoulder blade impact movements, including throwing. Abnormalities of any part of this complex linkage can lead to shoulder dysfunction and ultimately to pain when throwing. The most common abnormality is tightness of the posterior shoulder capsule, causing a loss of normal internal rotation of the shoulder. If this is causing your pain, you may notice that when you reach behind your back, you can't reach up as high on the side with the painful shoulder. Anatomy of the Shoulder Joint Symptoms of a Shoulder Problem Whether you're a professional baseball pitcher or playing catch with your child in the yard, shoulder-function abnormalities can cause significant pain. Some symptoms of a shoulder problem include: Aching pain: Often deep in the shoulder or extending down the upper arm"Dead arm": Lack of strength in the throwing motionNight pain: Pain isn't too bad when throwing but can awaken you from sleep Diagnosis When you go to your healthcare provider to get help for your shoulder pain that's associated with throwing, they'll need to understand exactly where the abnormality is in the throwing motion. It's helpful to find a healthcare provider who is familiar with throwing mechanics and shoulder injuries. They can best determine if there is a structural abnormality that needs to be addressed. Your provider will ask about your symptoms and perform a physical examination. Diagnostic Tests Tests to diagnose shoulder pain can be helpful, but only when placed into the context of the symptoms you're experiencing. Often, abnormalities may be seen on a magnetic resonance imaging (MRI) test, but these may or may not be the source of shoulder pain. Treatment Most people who experience the spontaneous onset of pain with throwing can improve with non-surgical treatments. The earliest phase of treatment is resting the joint and reducing inflammation. Treatments may include: Ice Anti-inflammatory medications Cortisone injection Once the acute symptoms of inflammation have subsided, it's important to address the source of the discomfort. Treatment can be targeted to the problem. Usually, a physical therapist can guide you back to full shoulder mobility and strength. Physical Therapy One of the most common scenarios is when a person who doesn't regularly throw develops pain after an unusual amount of throwing, such as for recreational sports or coaching a children's program. A structured shoulder stretching and strengthening program almost always alleviates the pain in these cases. Physical therapists often focus on scapular mobility when managing shoulder joint problems. Exercises may involve: Stretching to improve internal rotation or any other lost motion can help allow a more normal throwing motion.Strength exercises are often aimed at the rotator cuff, as these muscles initiate proper shoulder movements and stabilize the shoulder joint. Maintaining flexibility of the periscapular muscles (muscles that attach to the scapula bone) is important to ensure that the scapular movements are coordinated with the throwing motion. Most cases of shoulder pain when throwing will improve with supervised therapy. If you don't make improvement with three months of therapy, or can't return to competitive sports within six months, you may need to consider surgery. Summary The throwing motion is a complex shoulder movement that requires normal mechanics of interconnected muscles, tendons, ligaments, bones, and joints. When the mechanics of the throwing motion are altered, inflammation is often the result, and discomfort is a frequent symptom. The good news is that noninvasive treatments to improve the mechanics of the shoulder joint are often effective at relieving symptoms of shoulder pain when throwing. An Overview of Sports Injuries 4 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Wardell M, Creighton D, Kovalcik C. Glenohumeral instability and arm pain in overhead throwing athletes: A correlational study. Int J Sports Phys Ther. 2022 Dec 1;17(7):1351-1357. doi:10.26603/001c.39800 Itoigawa Y, Koga A, Morikawa D, Kubota A, Uehara H, Maruyama Y, Takazawa Y, Ishijima M. Posterior shoulder stiffness was associated with shoulder pain during throwing in college baseball players: assessment of shear wave elastography. Eur J Orthop Surg Traumatol. 2022 May 18. doi:10.1007/s00590-022-03286-z OrthoInfo from the American Academy of Orthopaedic Surgeons. Shoulder Injuries in the Throwing Athlete. OrthoInfo from the American Academy of Orthopaedic Surgeons. Shoulder Impingement/Rotator Cuff Tendinitis. Additional Reading Edwards P, Ebert J, Joss B, Bhabra G, Ackland T, Wang A. Exercise rehabilitation in the non-operative management of rotator cuff tears: A review of the literature. Int J Sports Phys Ther. 2016;11(2):279-301. By Jonathan Cluett, MD Jonathan Cluett, MD, is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit