A ‘throwing shoulder’ is unique due to the large amount of mobility required to achieve the throw as well as the force required to complete the action. Achieving this task in a professional environment requires continuous training which commonly leads to muscular imbalances and injury. Common adaptations lead to stiffness of the shoulder in one direction and more mobility to the opposite. This leads to additional muscle imbalances which disturb the control of the shoulder.
Over a period of time this will lead to repeated micro-injuries in the surrounding structures and lead to shoulder impingement. Shoulder impingement refers to the pinching of soft tissue structures between the shoulder during movement. Pressure along some structures with shoulder movement is common, however chronic irritation will lead to swelling, poor biomechanics and it will lead to pain.
Bursitis in the shoulder refers to a pathologic inflammation of the sub-acromial bursa which has been inflamed due to an injury or due to chronic compression. A chronic shoulder impingement may lead to bursitis which is an extremely painful pathology
Examination will reveal pain and you may have difficulty elevating the arm due to pain. There may be underlying shoulder weakness due to irritation of the tendons. Functional daily tasks may become difficult because of the inability to use the shoulder as previously. Specific assessment manoeuvres will help guide the clinical examination towards diagnosis and specific radiology investigations with ultrasound may be used to further investigate and exclude other tissue damage. Contributing factors to a shoulder impingement are the spine and shoulder blade mobility as well as muscle balance. Poor mechanics in the latter may lead to impingement.
The management of the throwing shoulder is conservative with good outcomes. This is achieved with ice, anti-inflammatory medication, and activity modification, followed by correction of structural abnormalities and strength imbalances.
In cases of severe bursitis a corticosteroid injection may be used directly into the bursa. This has good outcomes and will be used in a shoulder that has failed conservative management. Return to sport is achieved with addressing all functional and structural abnormalities and completing testing criteria pain free.