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Shoulder injuries

There are two main types of shoulder injuries which affect cricketers.

The first type is an “overuse” injury of the shoulder, associated with throwing, typically referred to as “thrower's shoulder”. The second type refers to acute, traumatic injuries, especially when players fall on a shoulder while fielding.

Thrower's shoulder is a chronic shoulder pain that gradually worsens when the player throws the ball, and, at a later stage, even when the player is bowling. There are a number of potential causes: poor throwing technique, shoulder muscle imbalance, previous injury, shoulder instability, too much or too little practice, and poor posture.

Thrower's shoulder involves injury to the tendons of the rotator cuff (the muscles around the shoulder joint), and may include weakness around the scapula (shoulder blade). There may be associated bursitis (inflammation of the joint sac) within the shoulder.

One specific mechanism for the development of thrower’s shoulder  is the stretching of the anterior ligaments as a result of continuous throwing, which may lead to anterior instability. It may also involve posterior capsular tightness, leading to secondary damage: “SLAP” lesions and even partial tears of  the rotator cuff tendons may occur.

Management of this injury includes appropriate diagnosis and identification of all the potential causes of the shoulder pain. Pain management and rehabilitation are the two mainstays of treatment for this condition.

Rehabilitation is focused on both stability and strength around the shoulder joint. It is essential that there is a balance of strength and stability around the shoulder and surrounding joints. Rehabilitation and correction of the cricketer's throwing technique is important to prevent the recurrence of injury.

In cases where structural damage has occurred, the appropriate management would be referral  to a shoulder specialist for possible surgical repair.

Injuries caused by overuse of the acromion-clavicular joint ( ACJ ) also occur in these players, due to repeated overhead movements. Initial physiotherapy often cures the problem, but in certain instances surgical management might be required.

Traumatic injury to the shoulder classically occurs when a fielder dives for the ball and lands hard on an outstretched arm. The injury could include damage in the form of tears to the tendons, and/or cartilage, in and around the shoulder, and, in isolated cases, dislocation of the shoulder may occur. Pain caused by this kind of injury usually limits participation in the game.

Management includes appropriate diagnosis, which, in some cases, will require referral to an orthopaedic surgeon. If the injury is significant, surgery may be necessary. It is imperative that the treating surgeon should be have the knowledge to manage shoulder injuries in overhead athletes, in order to  ensure  appropriate treatment, which will enable the player to return to the same level of play as soon as possible.

Following this, it is essential that the cricketer be appropriately rehabilitated to prevent weakness of selected muscles, which may in turn lead to future overuse injuries.

Content reviewed and enhanced by Dr Joe de Beer, a well-known orthopaedic specialist, and T-J Malherbe, a physiotherapist. Both are from Cape Town.

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