The shoulder is vulnerable to acute injuries (dislocation, subluxation, fracture, muscle tears) as well as chronic injuries (tendinitis, bursitis) due to its location and use in overhand throwing and repetitive motions.
Acute Versus Chronic Shoulder Injuries
Common acute injuries include clavicular fracture, glenohumeral subluxation/dislocation, rotator cuff tear, and acromioclavicular sprain. Mechanism of acute injuries in the shoulder include player to player contact, player to surface contact, contact with playing apparatus, landing on tip of shoulder, landing on outstretched arm, and forceful rotation.
Common chronic injuries include bicipital tendinitis, impingement syndrome, rotator cuff strain, and bursitis. These injuries are caused by repetitive motion and are commonly seen in athletes who compete in baseball, softball, tennis, and swimming.
According to a study published in the Journal of Athletic Training (January/February, 2009), shoulder injuries are the fifth most common injuries in high school athletes. The authors reviewed data collected during the 2005-2006 and 2006-2007 academic years utilizing an on-line sports-related surveillance system (Reporting Information Online, Research Institute at Nationwide Children’s Hospital, Columbus, Ohio).
Shoulder injuries made up the greatest proportion of all injuries in the following sports:
- Baseball (17.7%)
- Wrestling (17.5%)
- Football (11.7%)
- Softball (10.4%)
The sports with the highest incidence of shoulder injuries included football, wrestling, and baseball for boys and softball and volleyball for girls. Injuries sustained in football and wrestling were more contact-type injuries whereas the injuries sustained by athletes in baseball, softball, and volleyball were non-contact type injuries.
Common Shoulder Injuries
Common shoulder injury diagnoses included:
- Sprains/strains (39.6%)
- Dislocations/separations (23.7%)
- Contusions (11.5%)
- Fractures (6.6%)
- Tendinitis (3.5%)
- Nerve injuries (2.5%)
- Inflammation (2.8%)
- Torn cartilage (1.9%)
The injuries were further classified into mild (less than one week loss from sport), moderate (more than three weeks out of sport) and severe (surgical repair). Injuries keeping athletes out of sport for more than three weeks included dislocation/separation (33.7%), fracture (27.5%), and sprains/strains (21.2%).
Mechanism of Serious Shoulder Injuries
Sports with the largest percentage of shoulder injuries requiring surgery included wrestling (8.5%), girls basketball (7.8%), and football (7%). Player-to-player contact was the primary mechanism for shoulder injuries that required surgery (59.8% of shoulder injuries requiring surgery), followed by contact with the playing surface (20.0%).
It is interesting to note that along with player-to-player contact being the mechanism of injury for shoulder injuries requiring surgery, player-to-player contact is also the mechanism of injury (58%) for injuries resulting in more than 3 weeks of time loss.
Preventing Shoulder Injuries
Having knowledge of the types and most common mechanisms of injury sustained in each sport can provide an important foundation for coaches and others working with young athletes towards preventing these types of injuries.
Overuse injuries can be prevented by reducing the number of repetitions during practices and focusing more on the mechanics of the movement rather than the quantity. Reduction of the intensity of the motions can also reduce overuse injuries (throwing or hitting at 75% rather than 100%) during portions of practice.
Player-to-player contact injuries can be reduced through proper instruction of technique. Player-to-surface injuries can be reduced by teaching athletes how to properly fall and roll to disperse the force of the impact off of the shoulder and on to the rest of the body.
Education can reduce injuries if the education leads to preventative measures in sport.
Terry Zeigler - Educating through writing with over twenty-five years of experience as a Kinesiology Professor and Certified Athletic Trainer.
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