Even if you’re not a professional athlete, participating in sports that require repetitive overhead motions can make you more susceptible to shoulder injuries.

“Shoulder injuries are commonly seen in baseball pitchers, but any athlete participating in sports that require repetitive overhead activity can be affected,” said Dr. Douglass Stull, a sports medicine physician and orthopedic surgeon with OrthoKansas. “Athletes who play softball, tennis, volleyball, swim or participate in track and field events — particularly javelin throwers — all have a higher risk of shoulder injury.”

If you notice pain that’s not going away, talk with your primary care physician or schedule an appointment with an orthopedic surgeon for an assessment. Some athletes might be tempted to play through the pain, but that can cause more problems down the road.

Common symptoms of a shoulder injury include:

• A deep pain in the shoulder during physical activity that improves with rest

• Lack of strength

• Feeling of a “dead arm” that doesn’t feel like it’s part of the body

• Decreased range of motion

Different types of injuries can show up depending on a person’s age and whether their skeleton is fully mature.

Stull said he commonly sees overuse injuries such as Little Leaguer’s shoulder in younger athletes. Athletes who are susceptible to this type of injury are called skeletally immature, or SI for short, because their skeletal growth plates are still open.

For athletes whose skeletons are mature, it’s more common to see overuse injuries, such as labrum and rotator cuff injuries.

Stull said there’s not a hard and fast age when it comes to skeletal maturity. It’s different for each person.

“Skeletal maturity happens sooner in females than males, so they won’t have SI injuries as late,” he said. “The most common age is between 11 and 13. As these athletes are going through puberty, muscles are getting stronger and the bones haven’t completely closed, so they’re adding new stress and power to a skeleton that isn’t completely mature.”

What to expect at the appointment

Stull said that at a patient’s first appointment, they can expect to undergo a thorough examination.

“I want to know more about why the patient came to see me and about their goals. I also need to know the extent of use or overuse of the shoulder and any treatment that’s already been performed,” Stull said. “After I perform a thorough shoulder exam, I share the blunt truth with the patient, and their parents or coaches as needed, about overuse, various treatment options and the reality of return to play.”

Patients sometimes need an X-ray or other imaging to help determine the extent of the injury. LMH Health partners with a team of musculoskeletal-trained radiologists from Radiologic Professional Services who are able to do the type of imaging that athletes need.

“Finding a problem when it’s subtle and early in the disease process can save a patient time — and sometimes intervention — so we can keep them at work, on the field, the golf course or just on a walk,” said Dr. Todd Oberzan, a musculoskeletal-trained radiologist.

Stull said specialized imaging can give other doctors the information they need to figure out precisely what’s wrong and how to treat it.

“The beauty of having (musculoskeletal-trained) radiologists is their connection with orthopedics,” Stull said. “Dr. Oberzan looks at an image and we’re able to communicate about it and zero in on the problem. He has the benefit of reading the exam notes and having access to all of the patient’s medical records.”

At LMH, orthopedics, imaging and therapy are all available at the West Campus.

Nonsurgical options

There’s a misconception that patients who see an orthopedic surgeon for help will always end up having surgery. In reality, orthopedic surgeons will exhaust conservative treatment options before discussing whether surgery is appropriate.

Nonsurgical treatment options can include rest; medication to reduce inflammation and pain; and physical therapy. The latter might include an assessment of throwing mechanics and looking for weaknesses and imbalances.

Dan Lorenz, director of sports medicine at LMH Health, said that on a patient’s initial visit, a therapist will examine not only the shoulder, but also the hips and knees.

“In overhead athletes, force transfers from the ground up,” he said. “Strong legs generate power through the torso, hips and spine, continuing through the shoulder. We look at your entire kinetic chain.

“Think of this as the parts of the body acting as a system of chain links and energy or force generated by one link is transferred to the next,” he added. “If there’s a weak link, that causes your shoulder to overcompensate.”

The therapist will then determine what exercises a patient will undertake and how long they can expect to be in therapy.

“Physical therapy isn’t a one-size-fits-all solution,” Lorenz said. “It’s individualized and specific to each patient based on their evaluation and history. A college baseball pitcher may present differently than an adult who plays recreational softball. There may be common exercises between the two, but each patient is different.”

Surgery

If medications and therapy don’t relieve pain and improve function, patients may need surgery to repair an injury or replace a joint.

“There are times when surgery is the route that’s best for the patient right off the bat,” Stull said. “Patients with gross instability of the shoulder as a result of traumatic injury and those with sudden tears of the rotator cuff aren’t candidates for physical therapy, so surgery is their best option.”

For patients who need surgery, it’s important to follow through with physical therapy, which should help decrease pain and improve function. Patients who’ve undergone surgery can expect to be in therapy for anywhere from three to six months.

“People that have the best outcomes following surgery are fully engaged and do what they’re supposed to do,” Lorenz said. He said that many people can expect between four and six months of therapy, but that shoulder replacement patients might only need three to four months in some cases.

“If you follow through with your at-home program and your therapist’s instructions, that time may be shortened,” he said.

— Autumn Bishop is the marketing communications manager at LMH Health, which is a major sponsor of the Journal-World’s Health section.