Jonathan D. Gelber, MD, MS; Lonnie Soloff, DPT, PT, ATC; Mark S. Schickendantz, MD


J Am Acad Orthop Surg. 2018;26(6):204-213. 

In This Article

Overview of Throwing Injuries and Stress

Effective pitching requires the generation of high levels of arm speed. By creating greater momentum, pitchers can impart more energy to the ball. The best pitchers are able to generate considerable arm speed through adaptive changes, a greater total arc of motion, and specific throwing mechanics.[1–3] Through this process, tremendous stresses are placed on the shoulder. Effective peak angular velocities for internal rotation have averaged 6,180 degrees per second during acceleration.[4] As a result of this violent acceleration and hyperabduction, the rotator cuff, capsulolabral complex, biceps tendon, and glenohumeral ligaments are all susceptible to stretch, peel-back, and delamination injuries via compressive and shear forces.[5–12] In contrast, the larger muscles groups, such as the latissimus dorsi, are less commonly involved.