Overuse Serves Up Tennis Shoulder Injuries

Tennis is a very popular sport around the world with many levels of skill from amateur/recreational to professional.Although tennis provides an excellent outlet for aerobic exercise, the activities associated with its participation come with some injury risks. Given tennis is an overhead sport, the shoulder is at risk for both overuse injuries as well as acute traumatic injuries. The most common shoulder injuries that occur involve the rotator cuff, the biceps tendon, and the labrum. Rotator Cuff The rotator cuff, on the top part of your shoulder, is often the site of overuse injuries from tennis. When the dominant shoulder is overworked, it can develop both internal and external impingement. Impingement is when the rotator cuff is irritated to a point where it is bothersome and painful, especially with serving. Without proper treatment and rest, this overuse can lead to an increased risk for a rotator cuff tear. External impingement occurs when there is imbalance of the muscle groups supporting the shoulder. Typically patients complain of shoulder pain and difficulty with overhead activities. These conditions are usually diagnosed by physical examination and treated most commonly with physical therapy, anti-inflammatory medications, and corticosteroid injections. In severe cases, surgical intervention may be required to repair the rotator cuff if it is torn and possibly release the shoulder structures to regain proper balanced range of motion. Biceps Pain in the front of the shoulder is especially associated with groundstrokes during tennis and may be an indication that there is inflammation and/or injury to the biceps tendon. Painful biceps tendon symptoms can occur because of repetitive twisting activities from the racquet swing that can be further increased with underlying stresses and muscle imbalances. These symptoms typically occur with shoulder pain that is worsened by raising, reaching, and lifting in the front portion of the body as well as serving and forehand strokes. The treatment for a painful biceps tendon is similar to the rotator cuff, starting with physical therapy, non-steroidal anti-inflammatory medications, and occasionally corticosteroid injections. When conservative treatment fails to provide symptom relief, surgical treatment may be necessary to allow full, pain free, return to sports participation. Superior Labrum The repetitive overhead activities inherent in tennis participation can also cause injury to the superior labrum or the area where the ligaments attach into the socket of the shoulder. Superior labrum anterior to posterior (SLAP) tears are a part of the spectrum of injuries that can occur along with a rotator cuff injury. SLAP tears cause deep shoulder pain that is frequently difficult to define by the patient but may commonly cause front and back shoulder pain. Symptoms are worsened with overhead serving along with a “dead arm” feeling during these activities. There can also be an accompanying painful click or catch in the shoulder during loading activities. Treatment is similar to what has been described for both the rotator cuff and biceps tendon injuries. Participation in tennis puts the shoulder at risk for a wide range of injuries that can limit participation due to pain. It is critical that athletes pay particular attention to proper form and technique to protect the structures of the shoulder from undue stresses. Additionally, it is equally important that tennis players maintain full range of motion and avoid tightness that can predispose the shoulder for injury. Seek medical attention early to allow for initiation of physical therapy and correction of shoulder mechanics.