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Question: My 15-year-old son has been developing shoulder pain in the back of the shoulder for the last two weeks. He is able to play but has pain after he stops. What do you recommend? Dan, Redondo Beach, CA
Dr. Dan Grobman: Shoulder pain is common in tennis players, and is usually from repetitive overuse. Good quality stroke mechanics are imperative to prevention of overuse injuries of the shoulder. The rotator cuff muscles/tendons can protect the shoulder joint, but they are subject to wear and tear if they are not in proper balance and strength.
They are primarily stressed with serving and overhead strokes, mainly due to the full external rotation of the shoulder followed by racquet head acceleration. This constant muscle stretching, especially after the ball is struck, fatigues and can potentially weaken shoulder muscles, increasing risk of rotator cuff injuries. Also, the rotator cuff muscles/tendons can be stressed from increased string tension, change in racquet weight, and string type (gut strings have been found to be more forgiving than synthetic strings).
The first step in addressing shoulder pain is to analyze stroke form, and frequency of practice and tournament play. Sometimes the shoulder is overly stressed because the player is not using other important muscle groups, such as the legs and low back, when hitting serves. Players often need to temporarily restrict strokes that worsen symptoms. If symptoms persist, best medical practice is to undergo an evaluation with a sports medicine physician or orthopedist. Because the growth plate is often not fused at this age, x-rays are sometimes obtained to rule out a growth plate fracture.
If the physician feels the shoulder pain is from muscle imbalance, the treatment often is to work with a physical therapist and/or strength and conditioning coach to improve muscle strength and balance. Sometimes the physician will also recommend short-term use of a nonsteroidal anti-inflammatory medication. If symptoms persist despite stroke improvement and muscle conditioning, the physician may obtain a shoulder MRI to rule out less common causes of shoulder pain such as a tear in the joint capsule or rotator cuff muscles/tendons.
About the Author
Dan Grobman, DO is a primary care sports medicine physician at Cleveland Clinic Florida
. He received his medical school training at Des Moines University in Des Moines, Iowa, and received his primary care residency training at Michigan State University, where he was also fellowship trained in Primary Care Sports Medicine. He is board certified in Family Practice and has a certificate of added qualification in Sports Medicine.