Shoulder Pain in Baseball Pitchers and Throwing Athletes

Author: Loyola University Health System
Published: 10 Dec 2014 - Updated: 12 Jun 2026
Publication Type: Research, Study, Analysis

Contents: Synopsis - Definition - Introduction - Main - Insights, Updates - Related Publications

Synopsis: This report, published in the journal Physical Medicine and Rehabilitation Clinics of North America, examines why shoulder pain is so difficult to evaluate and treat in baseball pitchers and other throwing athletes. Written by orthopedic surgeon Nickolas Garbis, MD, of Loyola University Medical Center and co-author Edward McFarland, MD, of Johns Hopkins University, it carries clinical authority drawn from specialists in shoulder and elbow injuries. The report explains that the shoulder's four joints, deep structures, and overlapping symptoms make diagnosis far less predictable than patients and coaches often assume, and it lays out a practical, experience-based approach to identifying abnormal findings. Because overuse injuries can begin in adolescence and affect anyone who relies on repeated overhead motion, the information is useful for athletes, parents, coaches, and seniors managing chronic shoulder problems alike.*

At a Glance

• 1 - Overhead throwing places heavy stress on the shoulder, one of the most mobile joints in the body, which leaves it especially vulnerable to injury across sports such as tennis, javelin, handball, and water polo
• 2 - Little League shoulder, an injury to the growth plate, is among the most common adolescent injuries, with traveling-team pitchers most at risk - adhering to pitch counts can reduce both injuries and fatigue
• 3 - When nonsurgical care fails, arthroscopic repair or trimming of partial rotator cuff tears returns as many as 89 percent of college and professional pitchers back to play

Topic Definition: Pitcher's Shoulder

Pitcher's shoulder refers to the range of overuse injuries and pain affecting the shoulder of baseball pitchers and other throwing athletes, caused by the rapid acceleration and deceleration of the arm during repeated overhead motion. Because the shoulder is composed of four joints and many deep, hard-to-examine structures, the same pain can stem from several sources, including rotator cuff tendinitis, rotator cuff tears, biceps tendinitis, shoulder instability, and stiffness. The condition spans a spectrum from adolescent growth-plate injuries such as Little League shoulder to chronic tears in adult athletes, and treatment typically begins with nonsurgical measures before arthroscopic surgery is considered.

Introduction

Results of treating shoulder pain in baseball pitchers and other throwing athletes are not as predictable as doctors, patients and coaches would like to think, according to a report in the journal Physical Medicine and Rehabilitation Clinics of North America.

Main Content

Nickolas Garbis, MD, an orthopedic surgeon who specializes in shoulder and elbow injuries at Loyola University Medical Center, is the primary author.

Shoulder pain occurs in athletes who play sports that require rapid acceleration and deceleration of the throwing arm. They include baseball pitchers, tennis players, softball pitchers and javelin throwers, as well as athletes who play handball and water polo.

Overhead throwing generates a large amount of stress on the shoulder, which is one of the most mobile joints in the body. This makes it vulnerable to injury.

It is difficult to diagnose the cause of shoulder pain.

The shoulder is comprised of four joints, and a problem with any of them can cause pain and affect performance. Moreover, many of these structures are deep in the shoulder and therefore difficult to examine by touch. Also, the same kind of pain can be due to multiple causes. For example, pain in the front of the shoulder can be due to rotator cuff tendinitis, rotator cuff tears, biceps tendinitis, shoulder instability, shoulder stiffness and several other causes.

"A systemic approach, and some experience, can help the clinician become more familiar with which constellation of findings in these athletes is not normal," Dr. Garbis and co-author Edward McFarland, MD, write.

Shoulder problems can begin during adolescence.

Little League shoulder, an injury to the growth plate in the shoulder, is one of the most common. Adolescent pitchers most at risk for injuries are those who compete on traveling teams. Overuse injuries can lead to more serious mechanical injuries. Adhering to pitch counts should reduce injuries and decrease fatigue.

Treatment should be primarily nonsurgical.

Nonsurgical options include icing the shoulder and judicial use of nonsteroidal anti-inflammatory medications such as ibuprofen and naproxen. Rehabilitation can restore a normal muscular balance. Rest can help, but it should not be prolonged, because the shoulder could become de-conditioned.

If nonsurgical options fail, arthroscopic surgery can be considered.

For example, surgical repair or trimming of partial rotator cuff tears can be highly successful, returning as many as 89 percent of college and professional pitchers back to play. However, the type of surgery needed depends upon the patient's shoulder problem.

Dr. Garbis is an assistant professor in the Department of Orthopaedic Surgery and Rehabilitation at Loyola University Chicago Stritch School of Medicine. Dr. McFarland is a professor in the Department of Orthopaedic Surgery at Johns Hopkins University.

Insights, Analysis, and Developments

Attribution/Source(s): This quality-reviewed publication was selected for publishing by the editors of Disabled World (DW) due to its relevance to the disability community. Originally authored by Loyola University Health System and published on 10 Dec 2014, this content may have been edited for style, clarity, or brevity.

* Editorial additions by Ian C. Langtree.