As the name suggests, thrower's shoulder is common in sports that involve throwing, but also in swimming and other activities where the shoulder is exposed to high loads over time. It is therefore not considered an acute injury.
A predisposing factor for this type of injury is increased external rotation and decreased internal rotation of the shoulder. It is often observed amongst athletes in sports that involve large ranges of motion in the shoulder joint such as with throwing and swimming.
When an athlete develops thrower’s shoulder, the load on their shoulder exceeds the load capacity. The anterior part of the shoulder joint capsule is gradually pulled and stretched. This can decrease the stability of the shoulder joint and may lead to injuries in the rotator cuff.
The rotator cuff can initially compensate for this by increasing muscle activity. However, continued activity can result in fatigue of the rotator cuff, making it difficult to maintain normal shoulder mechanics. This can lead to an increased risk of sustaining other overuse injuries in the shoulder, such as injuries to the labrum and rotator cuff.
The main treatment is a long-term, targeted rehabilitation program. The athlete should be removed from the activity or sport that caused the injury. A standardised rehabilitation program takes at least 12 weeks to complete. It is important to maintain good communication between the therapist, athlete, and coach because it can take as long as three to six months before the athlete can return to sport. It is advised to contact a physiotherapist who has experience in treating this type of injury.
The rehabilitation program aims to:
- Regain full range of motion in the shoulder
- Strengthen the rotator cuff muscles
- Restore normal movement of the shoulder blade and upper arm
If symptoms persist despite following a well-structured rehabilitation program, surgery may be necessary. Rehabilitation after surgery takes up to 12 months and follows the same principles as those outlined above.