Sports Injuries of the Shoulder

sports shoulder injuries

General Information About Sports Injuries of the Shoulder

Depending on the sport, an athlete may be at a high risk of suffering an injury to his or her shoulder. The sports which place an athlete at especially high risk of needing shoulder injury treatment involve those which require the repetitive or sustained use of the shoulder to make overhead motions. Sports like American or Rugby rules football, Volleyball, and Tennis are all sports which may put continuous stress on the muscles in the shoulder region and cause an injury.

As one of the larger muscle groups in the body, acute injuries to the shoulder are possible, but quite often the injury occurs over time and can result in a chronic condition. Without the proper care, shoulder region injuries can become an issue which either prevents an athlete from performing at the top of their game or potentially prevents them from playing at a highly-competitive level altogether.

However, due to the numerous different muscles in the shoulder and the variety of motions the ball-and-socket joint of the arm can perform, sports shoulder injury treatments and diagnoses may be difficult to determine from the outset. The process of a shoulder injury treatment is usually extended with ample amounts of downtime to simply let the injury heal itself. However, for highly competitive athletes, injuries to the shoulder may require invasive procedures to correct and return back to a competitive level of performance.

Types of Sports Shoulder Injuries

Some of the primary types of injuries to the shoulder muscle injuries, glenoid labral tears, and simple shoulder strains. While there are numerous studies that have sought to understand and explain the risks of shoulder pain in general and overhead injuries to the shoulder in specific, there is no agreement regarding what actions or events present the most risk. However, these injuries are often caused by specific events which may be acute or a result of chronic overuse. A reduction of a range of motion and weakness in the shoulder region muscles has been seen as contributing factors. Also of not, a posterior stiffness of the should also contribute to these types of injuries. Furthermore, these injuries themselves can develop into or exacerbate other conditions like impingement of brachial nerves or frozen shoulder syndrome if not treated quickly and effectively.

Anatomy of the Shoulder

The shoulder is a region of the body that has so many possibilities for injury because numerous soft tissues either begin, end or secure this region of the body. One of the largest joints in the body, the shoulder can roughly be understood as the point where upper arm meets the body. The humerus and the scapula—the bone most commonly referred to as “the shoulder.” These two bones connect with the clavicle to form the bony structure of the shoulder. However, the clavicle is not connected the shoulder joint proper. These bones are joined together by the glenohumeral joint. This is a ball-and-socket joint that allows 360 degrees of rotation. Though, it should be noted that the glenohumeral joint does not actually connect with the clavicle. Surrounding these bones and joint are various muscle groups, but the one most implicated in injuries to the shoulder are the rotator cuff muscles.

Primary Causes of Sports Shoulder Injuries

One potential cause of injuries to the shoulder emerge in the form of scapular dyskinesis. Though it should be noted that there is no clinical evidence directly suggesting the condition causes shoulder pain or injury, general soft tissue dysfunction commonly incites or agitates such issue formation. Part of the issue lay with the fact that proper scapular positioning is not homogenized, and a degree of asymmetrical positioning often produces no pain or affiliated conditions. Still, this specific condition may present in different ways as the bone in question may be misaligned in a variety of positions. Regardless, the scapula should be able to protract and retract within a 100 percent range in normal, healthy patients. Even if the scapular position is asymmetrical, the range may indicate a healthy function. Conversely, even if the scapular is symmetrical, an inhibited range of motion or pain during either protraction or retraction can be indicative of shoulder region injuries.

Scapular dyskinesis has also been linked to one of the most common causes of should issues which are an instability of the muscles and/or joint. This can also be caused by arthritis which will weaken the joint specifically. However, bursitis can also cause problems with the joint and eventually lead to issues with the muscles that attempt to compensate for the injured area. The muscles will tighten to provide added stability, and if left untreated over time, the muscles themselves will weaken due to chronic fatigue and will have an increased chance of injury. Regardless of the positioning of the scapula, general muscle fatigue is seen as one of the most probable causes of injury in the shoulder region. Unfortunately, for highly competitive athletes, during their period of activity, there is little that can be done to alleviate this aside from rest and restive techniques—which may include heat, cold, or physical therapy.

Another consideration when examining shoulder problems may identify nerve impingement as a cause. This is especially prevalent with the brachial plexus, the nerves that run from the cervical vertebrae and enervate the arms. There are two likely culprits for this condition, though both anterior muscles groups, as well as posterior muscle groups, may be the cause. In the front or anterior, part of the body the pectoralis minor and the acromion are the problematic site to consider. In the back or posterior, side of the body, the subscapularis muscle may be the source of brachial nerve impingement. The latter cause can also be exacerbated by scapular dyskinesis discussed earlier.

Prevalence of Sports Shoulder Injuries

Injuries to the shoulder are especially prevalent in sports that require an overhead motion. Baseball, volleyball, and swimming among others. For swimmers, the most common connection to injury involved overuse or poor technique. Over the course of 1000 hours of training, male swimmers had a rate of 4 injuries while female swimmers had a slightly lower rate of 3.78 injuries. Specifically, for shoulder pain, over 90 percent of swimmers between the ages of 13 and 25 reported having an episode of shoulder pain at least once.

With volleyball players, the most common occurrence for shoulder issues arises during serving or spiking accounting for up to 24 percent of all injuries sustained while playing volleyball. Of those injuries, the overwhelming majority were simple shoulder sprains without tearing or other, more serious concerns. This occurred between 64 percent to about 80 percent of the time. Still, other common sources of injury for the shoulder while playing volleyball include shoulder tendonitis, which can account for between 8 and 20 percent of shoulder related injuries.

However, it is interesting to note that baseball injuries were far more common to occur the earlier in the season. For instance, practice injuries were more than 3 times as common as game-time injuries. Furthermore, preseason practice injuries occurred at nearly 2 times the rate of the same injuries during the regular season. If that was not enough, regular season injuries were more common, though not more than 100 percent, than were postseason injuries. Part of this can be explained based on the idea that the soft tissues of the shoulder were worked too hard too quickly without the proper amount of time to adjust to the heavy workload that practices and workouts required. Moreover, as time progressed, the soft tissues adapted to the extensive use and were thus less likely to become injured.

Diagnosing a Sports Shoulder Injury

When diagnosing an injury to the shoulder, a clinician will first examine both shoulders to identify any dissimilarities. Asymmetrical positioning of the soft tissues may indicate the problem, however, as previously noted, a certain degree of asymmetry can be expected and unexceptional. In this instance, the clinician will look for other visible signs of injury like swelling or bruising. Following this visual assessment, a range of motion test is indicated, specifically checking the sternoclavicular joint as well as the acromioclavicular joint. Afterward, the next regions the clinician will check include what most would deem the shoulder, especially the muscle groups and other various soft tissues surrounding the glenohumeral joint. Testing for muscles weakness with resisted tension or light isometric exercises may be indicated depending on the type and severity of the injury.

Treatment for Sports Shoulder Injuries

Non-surgery based treatment will vary from injury to injury, but most will include restive techniques. Aside from general rest, these techniques can include ice and anti-inflammatory medication that is nonsteroidal. On occasion, this may require the limb to be placed in a sling—potentially up to weeks at a time. However, the tissues are far more likely to return to their previously healthy state without scarring or as much replacement with scar tissue.

Other conservative treatments for injuries to the shoulder include a range of motion exercises and strength building exercises. The latter of the two is especially necessary if the injury was caused by a weakness or asymmetrical strength in oppositional muscles or muscle groups. For overhead injuries to the shoulder, this will commonly present when the external rotator cuffs muscles become imbalanced with the other muscles of the group due to a decrease in strength incurred during repetitive overhead exertions.

Sports Shoulder Injury Treatment NYC

If you find yourself in need of sports shoulder injury treatment in NYC, there are a variety of clinicians who specialize in conservative and other non-invasive treatment approaches such as the New York Dynamic Neuromuscular Rehabilitation & Physical Therapy center. They specialize in the diagnosis, treatment, and rehabilitation of athletes suffering from sports related injuries. Moreover, they also provide the necessary therapy and rehabilitation services as a follow-up for those who require or elect for surgery. The head of the center, Dr. Kalika, can also devise a program to help assist with the prevention of sports related injuries in the future.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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