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Throwing Shoulder Injuries

Throwing Shoulder Injuries Overview

The shoulder is a ball and socket joint made up of three bones- humerus, scapula and clavicle. The bones and surrounding structures allow the shoulder to be the most mobile joint in the human body. With this mobility comes an increased risk of throwing shoulder injuries. Dr. Brian Waterman, orthopedic shoulder specialist, is highly trained and experienced in treating football shoulder injuries and baseball shoulder injuries in professional athletes, weekend warriors and the general, active population.

Overhead throwing places extremely high stresses on the shoulder and the anatomy that keeps the shoulder stable. The shoulder anatomy includes:

  • Bones of the shoulder: Includes the humerus (upper arm), scapula (shoulder blade) and clavicle (collarbone).
  • Glenoid: Shoulder socket where the head of the humerus fits into a socket in the clavicle.
  • Labrum: Strong, fibrous tissue that stabilizes the shoulder joint and serves as an attachment site for numerous ligaments and tendons.
  • Shoulder capsule: Ligament system that covers the shoulder joint and attaches the arm to the shoulder blade.
  • Muscles and tendons: The shoulder joint relies on a strong group of muscles and tendons to keep stability and range of motion. Some of these structures include the rotator cuff, biceps muscle and back muscles.

When athletes throw repeatedly at a high rate of speed, a large load of stress is placed on the structures that keep the humeral head in place in the glenoid socket. If one structure experiences weakness, such as the ligaments, other structures must handle the overload, leading to throwing shoulder injuries.

Baseball players frequently complain of shoulder pain, especially pitchers. The cause of pain is most often injury to the bones or ligaments and other soft structures of the shoulder joint. Common baseball shoulder injuries include rotator cuff injuries, labrum and SLAP tears, ligament tears, shoulder instability and shoulder impingement. Similar injuires may occur in athletes who participate in other overhead sports such as volleyball and tennis.

Symptoms of Throwing Shoulder Injuries

Typically, the athlete complains of shoulder pain that has become progressively worse. At the beginning, pain may only be felt during the overhead movements or immediately following activity. This is most often accompanied by decreasing performance such as loss of velocity or control. With time, the condition may worsen causing pain throughout the day and night, even with no extreme use of the shoulder joint.

Diagnosis of Throwing Shoulder Injuries

In order to diagnose baseball shoulder injuries, Dr. Waterman will perform a thorough medical history review and physical examination. The onset of symptoms, frequency of overhead movements and the nature of overhead motion will be examined in great detail. Dr. Waterman will examine the shoulder’s stability, strength and range of motion with a variety of tests. An MRI and X-ray may be performed to confirm the diagnosis and identify any associated shoulder problems.

Treatments of Throwing Shoulder Injuries

Throwing shoulder injuries can become debilitating if left untreated. It is recommended to visit a sports medicine physician at the onset of symptoms.


In many cases, the initial treatment is a non-surgical approach utilizing ice, anti-inflammatory medications and a physical therapy program. Dr.Waterman may also recommend modification of activities in your daily routine to help alleviate the pain. If rest, medications and physical therapy do not lessen the symptoms, a cortisone injection may be performed in Dr. Waterman’s orthopedic office.


If non-surgical treatment does not alleviate pain or increase shoulder stability or range of motion, Dr. Waterman may recommend arthroscopic shoulder surgery. The majority of throwing shoulder injuries can be treated with an arthroscopic approach. During the procedure, Dr. Waterman will use a small camera and special surgical instruments to repair soft tissue damage with minimum incision points. If the injury is too large or complex, an open surgery approach may be recommended.

At a Glance

Dr. Brian Waterman, MD

  • Chief & Fellowship Director, Sports Medicine, Wake Forest
  • Team Physician, Wake Forest University, Chicago White Sox
  • Military affiliation/Decorated military officer and surgeon
  • Learn more

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