Shoulder pain during sports activity in which it is necessary to raise the hand and arm above the head is relatively frequent and difficult to treat, for different reasons:
- The origin is uncertain. There is usually no initial trauma, but it is the cause of an overuse mechanism.
- A wide variety of conditions can cause it, but the specific cause can be difficult to diagnose.
- Non-surgical treatment is a challenge for specialized physiotherapists.
Biomechanics of the launch
At the moment of the impact of the racket with the ball are involved muscle groups of the lower extremities, abdomen, trunk and the most distal part of the upper limbs, to achieve the maximum acceleration power at the moment of impact. This coordinated movement has been known as the "kinetic chain of launch".
The athlete needs a range of extreme movement of his shoulder, which assists him to achieve maximum acceleration power at the moment of impact, but at the same time it is also necessary that there is sufficient stability at the joint level to prevent the occurrence of injuries By the enormous forces generated during this movement.
The athlete's shoulder undergoes a series of adaptations in response to the forces he must endure:
- Increased musculature of the dominant arm.
- Anterior inclination of the scapula.
- Shoulder asymmetry.
- Increased external rotation of the shoulder.
Diagnostic approach and complementary imaging tests
The initial evaluation of the traumatologist includes:
- In-depth analysis of the history of onset of pain.
- Physical exam:
- Range of movement and muscle power.
- Neurovascular and cervical examination.
- Magnetic resonance and / or resonance arthrography present greater sensitivity and specificity for the diagnosis of labrum lesions and partial lesions of the cuff.
Most Common Shoulder Injuries
Internal glenohumeral rotation deficit
Once the impact of the racquet with the ball has occurred, a deceleration phase begins in which the posterior capsule of the shoulder joint is tightened to slow the movement. The repetition of this phenomenon causes contractures of the posterior capsule, which eventually loses its normal elasticity. Typically, these athletes have an excess of external rotation and an internal rotation deficit. The treatment with the highest percentage of success (90%) consists of performing exercises aimed at recovering the elasticity of the posterior capsule.
In this lesion there is a rupture or pulling of the insertion of the long portion of the biceps at the upper border of the glenoid and labrum and is one of the most frequent lesions in these athletes. It is characterized by a decrease in power and deep pain in the shoulder.
It is recommended to start with a non-surgical treatment of the lesion and to proceed to the surgical repair if the symptomatology persists despite the physiotherapy. Surgical treatment consists of arthroscopic rupture repair.
The degree of injury is variable, ranging from inflammation or tendinitis, to partial breaks and less frequently complete breaks.
Although tendinitis and partial ruptures can be recovered with a more or less prolonged rehabilitation treatment, complete ruptures usually require the arthroscopic repair of the lesion.
The greater the complexity of the injury, the lower the rate of patients who manage to return to the competitive level prior to the injury.
This is a scapular asymmetry of the arm of the pitcher with respect to the contralateral, in which it is slightly inferior and anterior and presents a more developed musculature. The alteration of the position of the scapula is accompanied by an alteration in the mechanics of shoulder movement, which produces pain.
The treatment par excellence is the directed physiotherapy emphasizing the reeducation of the coordination of the periescapular musculature.
Instability and laxity
One of the most prevalent theories about the cause of shoulder pain in these athletes is that excessive ligament laxation secondary to overuse can lead to instability, so it is necessary to investigate the presence of joint structural lesions.
Initially the recommended treatment is non-surgical, although if it is not effective and if there are structural lesions, the arthroscopic surgical treatment is indicated.