Shoulder and Elbow Overuse Injuries

What is shoulder/elbow overuse syndrome?

Overuse syndrome is a condition in young athletes caused by repetitive motion and over practice. Sports medicine physicians at Midwest Orthopaedics at Rush (MOR) and athletic trainers are increasingly concerned that overuse syndrome is causing injuries to the developing musculoskeletal structure of young athletes. Midwest Orthopaedics at Rush sports medicine physicians believe more can be done to prevent overuse injuries. See what they say in this short video:

What are common shoulder/elbow overuse injuries?

Some of the conditions that can result from advanced overuse of the shoulder or elbow in young athletes include: tendinitis, shoulder instability, SLAP tears, shoulder impingement syndrome and ulnar collateral ligament (UCL) tears.

Rotator Cuff Tendinitis: This can occur when the rotator cuff tendons become irritated and inflamed.

Shoulder Instability/Dislocation: As the most versatile joint in the body, the shoulder may dislocate or become unstable due to overuse. Instability of the shoulder joint involves the humeral head (ball), which is located at the top of the humerus, moving out of the glenoid (socket). If it is a partial dislocation (sublaxation), the ball moves partially out of the socket, whereas a complete shoulder dislocation means the ball comes completely out of the socket. Shoulder instability can also vary based on the direction of the dislocation. The four directions include: anterior, posterior, inferior, or multi-directional. When a shoulder becomes unstable, it involves damage to the labrum and capsule.

SLAP Tear: A SLAP (Superior Labrum from Anterior to Posterior) tear or SLAP lesion is a type of labral tear most commonly seen in overhead throwing athletes such as tennis players and baseball players. The torn labrum seen in a SLAP tear is at the top of the shoulder socket where the biceps tendon attaches to the shoulder.

Impingement Syndrome: Shoulder Impingement syndrome is the inflammation of the rotator cuff tendons and bursa. It is caused by the acromion rubbing against the tendons and bursa when the arm is raised.

Ulnar Collateral Ligament Tear: The ulnar collateral ligament (UCL) helps connect and stabilize the upper arm bone (humerus) and the forearm bones (ulna). This ligament can be injured in throwing sports.

What causes overuse syndrome?

Experts believe that year-round specialized training for young athletes is contributing to the overuse epidemic. Without periods of rest or cross-training, young players continue to strain the same muscles over and over again. Other contributing factors include: starting the sport at a very early age, poor mechanics, poor practice or conditioning and genetics. Those factors, coupled with a developing skeleton that isn’t strong enough and underdeveloped growth plates, can lead to injuries. An example would be pitchers and catchers who practice year-round by participating on school teams, club sports, off-season training and private coaching sessions. These athletes continue to strain the same muscles over and over again. The question now becomes: How will this affect the daily life of players years later when they reach adulthood?

What are the symptoms of overuse syndrome?

Depending on the location and severity of the injury, symptoms of overuse syndrome vary from person to person. Symptoms that often coincide with overuse syndrome:

  • Pain during and after activity
  • Swelling and stiffness
  • Weakness/Instability
  • Inability to fully straighten the arm or put arm above head

More severe injuries can lead to a clicking feeling or noise when movement occurs.

Athletes in what sports are more prone to overuse syndrome?

Overuse syndrome can be experienced in almost any sport. All athletes who train too much are more prone to overuse syndrome. Athletes who compete in overhead sports, such as baseball, softball, tennis, lacrosse, volleyball, gymnastics and swimming are more at risk of wear and tear of the shoulder or elbow.

While baseball is thought to be the biggest contributor to shoulder and elbow overuse injuries, softball players can be affected too. Hear what one MOR physician, Dr. Nikhil Verma, has to say about softball players who use the windmill pitch:

How are overuse injuries treated?

The physicians at MOR say treatment sometimes is as simple as reducing the intensity, duration or frequency of the movement causing pain. In most cases, MOR physicians and athletic trainers recommend the athlete refrain from play in order to rest the stressed tissues. Ice and over-the-counter inflammatory medications will help reduce inflammation and pain. If the injury is severe enough, our physicians may recommend shoulder surgery.

For instance, Tommy John surgery, named after the former Los Angeles Dodgers pitcher, is often a method of treatment for UCL tears in athletes, especially in baseball. More formally known as ulnar collateral ligament (UCL) reconstruction, the surgeon takes a tendon from the forearm and uses it to repair the injured ligament and stabilize the joint. Unfortunately, it may be 12 to 18 months before the athlete can return to his or her sport. Arthroscopic instability surgery may be necessary to keep the shoulder joint from repeatedly dislocating. However, this surgery can have excellent results.

Midwest Orthopaedics at Rush and Rush University Medical Center recently conducted a study of the impact of Tommy John surgery on the post-surgery performance of major league players. Their research found that a successful surgery not only puts MLB pitchers back on the mound, but, in many cases, also improves their game. The study showed four of five MLB pitchers who underwent ulnar collateral ligament surgery pitched as well or better than before their injury.

Why should you be concerned?

According to the Centers for Disease Control and Prevention, more than five million children under the age of 18 suffer a sports-related injury each year, with approximately half of these due to overuse. And, The American Journal of Sports Medicine recently published a study which showed that 75% of baseball players under 18 have arm pain – and many fail to report it.

A Safe Kids survey indicates that one in three children who plays team sports suffers injuries severe enough to require medical treatment. The same survey showed that nine out of ten parents underestimate how long children should refrain from playing any one sport in order to protect them from overuse, overtraining and burnout. Ninety-two percent of parents said they rely on coaches to keep their children safe while playing sports, but nearly half of all coaches said they have felt pressure to play an injured child in a game. Moreover, three out of ten children think a good player should keep playing even when he or she is hurt, unless a coach or other adult makes them stop.

In most cases, overuse causes short-term symptoms and pain. However, Midwest Orthopaedics at Rush orthopedic surgeons have noted that overuse syndrome can lead to permanent changes to the body, resulting in lifelong problems. Studies show that kids who participate in a single sport for 12 months per year are four to five times more likely to have a serious injury that may require surgery.