Throwing shoulder pain in adult baseball, softball and cricket players usually comes from the rotator cuff, the labrum (the rim of cartilage around the socket), the biceps tendon or a tight back of the shoulder. Throwing turns the arm back hard and then slows it down fast, and both phases load these structures. Most overuse throwing pain settles over 6 to 12 weeks with less throwing, strength work and a graded return.
Young throwers are different. A child or teenager with shoulder pain from throwing should stop throwing and be checked, because the growth plate at the top of the arm can be involved.
Key takeaways
- Common sources: the rotator cuff, the labrum, the biceps tendon and a tight back of the shoulder cause most adult throwing shoulder pain.
- Phase of the throw: deep pain at the top of the cock-back points more toward the labrum and underside of the cuff; pain in follow-through points more toward the cuff as it slows the arm.
- Typical course: most overuse throwing pain settles over 6 to 12 weeks with reduced throwing, strengthening and a graded return.
- Young throwers: shoulder pain in a child or teenager who throws should stop throwing until a doctor has checked it.
The common problems, by part of the shoulder
Outer upper arm: rotator cuff
The rotator cuff holds the ball in the socket and slows the arm after release. Rotator cuff pain (tendinopathy) is an ache on the outer upper arm, often worse in follow-through and after long sessions. Partial tears on the underside of the cuff are common in long-term throwers and feel similar, with more weakness.
Deep and at the back: internal impingement
With the arm fully cocked back, the underside of the cuff and the back of the labrum can be pinched between ball and socket (internal impingement). It causes deep pain at the back of the shoulder at the top of the cock-back.
Deep with catching: labral tear
A SLAP tear is a tear at the top of the labrum, where the biceps tendon attaches. It tends to cause deep pain with catching or clicking, loss of velocity and sometimes a dead arm, a sudden heavy, weak feeling during or after a throw.
Front of the shoulder: biceps tendon
Biceps tendon irritation causes pain at the front of the shoulder, tender over a groove at the front of the upper arm. It often appears alongside cuff or labral problems.
Back of the shoulder: tightness
Many throwers lose some inward turn on the throwing side, often from a tight back of the shoulder (posterior capsule). A large loss is linked with shoulder and elbow pain.
Young throwers: growth plate pain
In children and teenagers, the growth plate at the top of the upper arm is weaker than the tendons around it, and repeated throwing can irritate it. This is often called Little League shoulder (proximal humeral epiphysiolysis). It causes pain on the outer upper arm with throwing and usually needs a full break from throwing, often about 3 months, before a graded return. A doctor confirms it.
The shoulder throws the ball last. What happens below it decides how hard it has to work.
Early warning signs
- Losing velocity or accuracy: the ball does not come out the way it did, without an obvious reason.
- A longer warm-up: it takes more throws than usual before the arm feels loose.
- Next-day soreness: an ache that is still there the next morning, or is worse than after the last session.
- Dead arm moments: a brief heavy, weak feeling during a throw.
Load and technique changes
- Count your throws: youth leagues set pitch counts and rest days by age, and following them protects young arms. Adults benefit from the same habit: count warm-up, bullpen and fielding throws, and avoid sudden weekly jumps.
- Rest between hard days: a hard throwing day usually needs one or more lighter days after it.
- One season at a time: throwing year-round, or for two teams at once, raises the load with less recovery.
- Use the legs and trunk: they create most of the speed in a throw. When they are weak or out of sequence, the arm tends to compensate.
- Keep the back of the shoulder moving: gentle stretching for the back of the shoulder, if a physical therapist finds it tight, plus rotator cuff and shoulder blade strength through the season.
- Cricket: long throws from the boundary and heavy bowling spells add load. Count them too.
A return plan by stage
- Settle (often 1 to 3 weeks): no throwing or a large cut in throws. Keep lower body and trunk training. Start gentle cuff and shoulder blade work.
- Build (often weeks 2 to 6): strength through a wider range, including the cocked-back position, at slow speed first.
- Interval throwing (often weeks 6 to 12): short-distance easy throws, then longer distances, then more effort, with rest days between sessions. Move up a step when the shoulder is comfortable during and the next day.
- Back to full play: pitchers and bowlers often return later than position players. After a SLAP repair or other surgery, return to throwing often takes 6 to 12 months; your surgeon’s protocol comes first.
Where else this could be coming from
- The neck: a nerve root in the neck can cause pain over the shoulder blade, a heavy arm or tingling down the arm. Neck movement tends to change it.
- Upper back and shoulder blade: a stiff upper back limits trunk turn and can leave the shoulder blade sitting or moving differently.
- The elbow: pain on the inside of the elbow is common in throwers and often comes from the same load. The elbow, wrist or hand need their own assessment.
Call your local emergency number or go to the emergency department if
- Shoulder out of place: the shoulder looks out of shape or will not move after a fall or a throw.
- Circulation: the arm or hand turns cold, pale, blue or swollen, especially after a long throwing session.
- Chest symptoms: shoulder pain comes with chest pain, breathlessness or sweating.
See a doctor today if
- Swollen, discolored arm: the whole throwing arm becomes swollen, heavy or bluish, which can come from a clot in the vein near the collarbone.
- Sudden loss of strength: you suddenly cannot lift or throw after a pop in the shoulder.
- A young thrower: a child or teenager has sharp shoulder pain while throwing, or cannot throw because of pain.
Get it checked soon if
- Dead arm keeps returning: the arm goes dead more than once.
- Catching or locking: the shoulder catches or clicks with pain during throws.
- No change: pain has not clearly improved after 2 to 3 weeks of reduced throwing.
- Tingling: tingling or numbness in the fingers during or after throwing.
More on this area: neck and shoulder pain by job and sport.
The first warning sign is the easiest point at which to change how much you throw.
Written by Louise Yow, Neck & Shoulder Physio.