Orthopedics Shoulder & Elbow Treating Shoulder Pain When Throwing in Sports By Jonathan Cluett, MD twitter linkedin Jonathan Cluett, MD, is a board-certified orthopedic surgeon with subspecialty training in sports medicine and arthroscopic surgery. Learn about our editorial process Jonathan Cluett, MD Medically reviewed by Medically reviewed by Stuart Hershman, MD on July 06, 2020 linkedin Stuart Hershman, MD, is a board-certified spine surgeon. He specializes in spinal deformity and complex spinal reconstruction. Learn about our Medical Review Board Stuart Hershman, MD on July 06, 2020 Print Table of Contents View All Table of Contents Motion of Throwing Symptoms Diagnosis Treatment The motion of throwing a ball is complex and requires a healthy functioning shoulder in which muscles, tendons, ligaments, and bone all move in a synchronized and stable pattern. Because of this complexity, subtle abnormalities can lead to shoulder pain and discomfort. 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. Abnormalities in any of these functions can lead to pain and even damage inside the shoulder. The pain may come from the: Shoulder bladeShoulder joint (cartilage and labrum)Rotator cuff muscles and tendonsNerves that control the function of the muscles Once the source of the discomfort is identified, treatment can be targeted at the appropriate site of the problem. An often neglected aspect of shoulder mobility is the function of the shoulder blade, which includes the socket of the ball-and-socket shoulder joint. In order for the ball-and-socket to function normally, the shoulder blade must also function normally. The shoulder blade is attached to the chest wall with ligaments, muscles, and tendons. The various muscles and tendons that control movement of the shoulder blade can all impact movements, including throwing. For this reason, physical therapist often focus on scapular mobility when addressing shoulder joint problems Anatomy of the Shoulder Joint Symptoms 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. 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 doctor about shoulder pain when throwing, they'll need to understand exactly where the abnormality is in the throwing motion. It's helpful to find a doctor familiar with throwing mechanics. Tests to diagnose shoulder pain can be helpful, but only when placed into the context of the symptoms you're experiencing. Often, in young athletes and weekend warriors, abnormalities may be seen on an MRI, but these may or may not be the source of shoulder pain. That's where a skilled examiner familiar with shoulder injuries can help to determine if there is a structural abnormality that needs to be addressed. Finding a Specialist in Sports Injuries 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: IceAnti-inflammatory medicationsCortisone injection Once the acute symptoms of inflammation have subsided, a therapist can guide you back to full mobility and strength of the shoulder. The most common abnormality is tightness of the posterior shoulder capsule, causing a loss of normal internal rotation of the shoulder (patients may notice when they reach behind their back, they can't reach up as high on the side with the painful shoulder). 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 are critical to initiating proper shoulder movements and stabilizing the shoulder joint. In addition, the periscapular muscles (muscles that attach to the scapula bone) are important to ensure that the scapular movements are coordinated with the throwing motion. Most cases of shoulder pain when throwing will improve with these steps. 6 Ways to Prevent Sports Injuries One of the most common scenarios is a middle-age person who doesn't regularly throw and develops pain after an unusual amount of throwing either for recreational sports or in coaching for a children's program. These people usually have very poor shoulder mechanics and trying to just pick things up where they left off years before is ineffective. Performing a structured shoulder stretching and strengthening program almost always alleviates the pain in these cases. 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. A Word From Verywell The throwing motion is a complex shoulder movement that requires normal mechanics of interconnected muscles, tendons, ligaments, bones, and joints. Abnormalities of any part of this complex linkage can lead to shoulder dysfunction and ultimately to pain when throwing. 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. Average Recovery Times for Sports Injuries Was this page helpful? Thanks for your feedback! Dealing with joint pain can cause major disruptions to your day. Sign up and learn how to better take care of your body. Click below and just hit send! Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article 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. OrthoInfo from the American Academy of Orthopaedic Surgeons. Shoulder Injuries in the Throwing Athlete. Last reviewed March 2013. OrthoInfo from the American Academy of Orthopaedic Surgeons. Shoulder Impingement/Rotator Cuff Tendinitis. Last reviewed February 2011. 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. Tonino PM, et al. Complex Shoulder Disorders: Evaluation and Treatment. J Am Acad Orthop Surg March 2009 ; 17:125-136.