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Question: I have pain in the front of my shoulder when I serve. How best can I reduce the pain and do you have any ideas what may have caused it?
Sammy D., Burlington, VT
From Dr. Gary Windler:
Shoulder pain in overhead athletes (tennis players, baseball pitchers, volleyball players, etc.) is very common. In tennis, the fast speeds at which the shoulder rotates on the serve puts high stresses on the small muscles and tendons around the shoulder (rotator cuff). In addition, unlike the socket of the hip joint the shoulder socket is relatively shallow. The shoulder therefore relies heavily on the muscles, ligaments and labrum (rim of the socket) for stability of the ball within the socket.
If you consider that in an average 3-set singles match, a player generally hits between 125 – 150 serves, it is not surprising that shoulder pain and shoulder injuries are common tennis ailments. In fact, shoulder problems typically rank second in frequency only to lower back problems in the players on the ATP World Tour and this is similar to the injuries seen in junior US tennis players as well.
Degeneration and partial or complete tears of the rotator cuff and biceps tendon are common conditions seen in the tennis player’s shoulder. Tears of the labrum can also cause pain in the front part of the shoulder, especially during the service motion. Unfortunately, it is impossible to be sure which of these conditions is causing your particular problem. More information such as your age, level of play, the exact location of your pain and which part of the service motion is most painful would be helpful in determining the source of your pain and recommending appropriate treatment.
Despite the lack of a definite diagnosis of your shoulder problem, there are some general steps that you can follow which you may find helpful in reducing the pain and speeding your recovery:
1. Avoid any activities, on-court as well as off-court, which produce the pain in the front of your shoulder. If you only experience pain while serving, take a few weeks to work on improving your ground strokes and volleys while not doing any serving. If your shoulder hurts with ground strokes as well, you may need to take some time off from tennis. In that case, make sure to maintain your fitness with other exercises such as, biking, walking or running.
2. Begin a program of tennis specific shoulder stretching and strengthening exercises (see USTA Sports Science website - http://www.usta.com/Improve-Your-Game/Sport-Science/SportScience). Make sure to stop doing any exercises that reproduce the pain in the front of your shoulder.
3. A gradual return to hitting and serving can be attempted after a reasonable period of time, and when there is no pain with daily activities. Do not try to hit through the pain as this is more likely to aggravate the condition. A good dynamic warm-up (see USTA web site) prior to and application of ice following hitting is helpful when recovering from a shoulder injury.
If pain persists despite following these recommendations, a careful examination of your shoulder by a practitioner with experience in athletes’ shoulder injuries is warranted. X-Rays and/or an MRI or ultrasound scan may be necessary to help determine the cause of your pain.
Dr. Gary Windler, an orthopedic sports medicine specialist in Charleston, South Carolina, has been a member of the USTA Sport Science Committee for the past 5 years. An avid tennis player with a special interest in tennis medicine, he served as the ATP Traveling Sports Medicine Fellow in 2000 and has been a medical advisor to the ATP World Tour since that time. He has served as the Chief Tournament Physician for the WTA Tour Family Circle Cup. In addition, he currently serves as a team physician for Charleston Southern University, the South Carolina Stingrays ECHL team and the Charleston Riverdogs minor league baseball team.