Throwing Athlete Injuries

Definition

• Spectrum of overuse and acute injuries occurring in athletes performing repetitive overhead throwing

• Most commonly affects:

  • Shoulder

  • Elbow

Biomechanics

Throwing motion consists of 6 phases:

• Wind-up

• Early cocking

• Late cocking

• Acceleration

• Deceleration

• Follow-through

Highest stress:

• Late cocking & acceleration phases

Key Pathomechanism

• Repetitive valgus stress (elbow)

• Repetitive external rotation + shear (shoulder)

Leads to:

• Microtrauma → cumulative injury

Common Injuries

Shoulder Injuries

1. Internal Impingement

• Posterior rotator cuff + labrum impingement

• Seen in late cocking phase

2. SLAP Tears

• Superior labrum injury

• Due to traction + peel-back mechanism

3. Rotator Cuff Pathology

• Partial-thickness tears

• Tendinopathy

4. Glenohumeral Internal Rotation Deficit (GIRD)

• Loss of internal rotation

• Key risk factor

Elbow Injuries

1. Ulnar Collateral Ligament (UCL) Injury

• Valgus overload

• Most important elbow injury

2. Valgus Extension Overload (VEO)

• Posteromedial olecranon impingement

3. Medial Epicondylitis

• Flexor-pronator overuse

4. Osteochondritis Dissecans (OCD)

• Capitellum

• Common in young athletes

Clinical Presentation

• Progressive pain

• Decreased velocity

• Loss of control

• Fatigue

Physical Examination

Shoulder

• GIRD assessment

• Apprehension test

• Internal impingement sign

Elbow

• Valgus stress test

• Moving valgus stress test

• Posteromedial tenderness

Imaging

X-ray

• OCD lesions

• Osteophytes

MRI

• Labrum

• UCL

• Rotator cuff

Ultrasound

• Dynamic UCL assessment

Treatment

Nonoperative (First-line)

Components

• Rest

• Activity modification

• Physiotherapy

Focus:

• Scapular stabilisation

• Posterior capsule stretching (GIRD)

• Core strengthening

Operative Treatment

Indications

• Failed conservative treatment

• Structural injury

Examples

• UCL reconstruction (Tommy John surgery)

• SLAP repair

• OCD fixation

Prevention

• Pitch count limits

• Proper mechanics

• Rest periods

• Address GIRD early

Complications

• Chronic instability

• Recurrent injury

• Performance decline

Prognosis

• Good with early diagnosis

• Elite athletes may require surgery for return to play

Pits & Pearls

• GIRD is a major modifiable risk factor

• UCL injury = most critical elbow pathology

• Internal impingement often coexists with SLAP

• Early rest prevents chronic injury

Pitfalls

• Ignoring early pain

• Continuing play despite symptoms

• Missing combined injuries

• Over-reliance on imaging

Mini Decision Algorithm