As with many orthopedic injuries, repetitive motion like throwing can create an excessive stress on shoulder and elbow tendons and ligaments. Repeated stress can also tear the ligament and tendon away from the bone and can even pull off tiny bone fragments. In the case of children, normal bone growth can be affected if this condition is left untreated.  As children are starting to play sports competitively much younger and continue to play at a high level throughout their entire career, injury recognition is key to preventing further damage that could potentially lead to career-ending problems. 

Symptoms of Injury

The symptoms of a throwing injury can include shoulder pain or elbow pain, a reduced range of motion and, with the elbow, the tendency for the joint to lock.  Tendonitis or frayed tendons are most commonly caused by, surprisingly enough, a lack of functional strength in certain muscles. 

These athletes have been conditioned to throw using a certain technique throughout the majority of their lives.  The muscles necessary to recreate that technique time and time again are very strong, but the surrounding muscles may not be activated nearly as much as they should be. Muscles insert via a tendon to bone, and will usually cross bony prominences, or bumps on the bones, to get to their insertion point.  For a strong, healthy muscle, tendons have enough slack to reach their insertion point without obstacles, but remain taut enough to keep the tendinous portion from rubbing on the bony prominences they cross. 

When the muscles are not activated regularly (strengthened properly), these muscles will get pulled in whichever direction the strong, frequently-utilized muscles are willing the bones.  For example: if pectoral muscles in the chest are tight and the scapular stabilizers between the shoulder blades aren't fired enough, their weakness will allow the tightness of the pectorals to round the shoulders forward.  This will lead to poor posture, and potentially cervical issues. 

When these weak muscles get pulled in a different direction due to lack of strength, their tendons rub constantly over the bony prominences - and this is worsened by repetitive motion, such as throwing. This will fray the tendinous portion of the weak muscles over time, until eventually there is too much inflammation, causing fairly debilitating pain, or until the tendon tears. 

Treatment Options

The most common treatments include resting and icing the affected area to reduce inflammation. As difficult as it is to pull players out of games and practice at such a high level, it's vital that any injury be treated as soon as possible to prevent further damage.

NSAIDs such as ibuprofen may be helpful to ease pain and inflammation, and physical therapy may be recommended by an orthopedic specialist. Physical therapy will strengthen the muscles around the damage to relieve them from the strain of bony prominences. This can relieve pain, but will likely not repair damages in the tendons. In some cases, surgery may be necessary to repair rotator cuff tendons in the shoulder or ligaments on the inside of the elbow to restore proper function and throwing mechanics and reduce pain.  Surgery is a more common solution for older athletes - high school and up, and most likely due to chronic symptoms and extensive damage over time as compared to a single incident. 

Common Throwing-related Conditions

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