On this video, you’ll learn about why your shoulder hurts when you’re playing tennis.

Hello, this is Siddharth Tambar from Chicago Arthritis and Regenerative Medicine, where we specialize in evaluation and treatment of arthritis, tendonitis injuries, and back pain. Shoulder pains are a common injury and symptom that people who play tennis experience. And the reason why is because of the above the head activity that’s done when you’re serving and hitting overheads.

To understand this you have to first understand the anatomy that’s involved at the shoulder. To begin with, there’s three different joints, the glenohumeral joint, the acromioclavicular joint, and the sternoclavicular joint. These are supported by multiple different layers of soft tissue structures, including the rotator cuff tendons. That’s four different rotator cuff tendons as well as a biceps tendon that help to provide power and support with the shoulder as it goes through a range of motion. There’s also quite a few different ligaments that help to attach the bones together. These ligaments provide stability as your shoulder is moving through that range of motion. There’s quite a few different nerves involved as well that starts with the nerves that come from the neck, then the brachial plexus, and then the peripheral nerves. These nerves help it coordinate and control your range of motion as your shoulder is in action. When all of this is combined together, your shoulders are able to go through a very wide range of motion with strength and stability and without pain.

If you have pain, it’s a sign that one part of that anatomy or process has been injured or is dysfunctional. The concept of biotensegrity, which means that the overall structural unit is stronger than the individual components, would indicate that if you have even one structure that’s not working optimally, it can then cause significant pain and dysfunction throughout the entire shoulder.

To understand why you can develop pain if you’re playing tennis, it’s important to understand the overall injury pattern that classically develops. Typically when you’re swinging above the head, such as when you’re either hitting an overhead, or with a serve, you are putting additional stress on the structures of the shoulder. As an example, if you have a strain in one of the ligaments of the shoulder, in particular the inferior glenohumeral ligament, that can lead to instability in that shoulder joint, which then leads to more stress on the rotator cuff above the ligaments, which then ends up leading to an injury of the rotator cuff tendons. Which can then either just be a mild injury or even a tear. That injury then can then lead to more stress on the acromioclavicular joint which sits even further above the rotator cuff tendon. All that combined together is what then leads to pain and dysfunction. What’s important to understand is that these are layers of tissue on top of each other that move in a coordinated fashion. As one layer gets injured, the layers above and below that can then also be injured and progressively get damaged.

So what should you do if you have an injury to the shoulder as a tennis player? First and foremost, obviously rest. Alter any of the activities that may be aggravating the pain as well. I would strongly recommend also having your serve videotaped, and the reason why is because if there’s any abnormal motion as you’re serving that’s putting more stress on the shoulder, that’s something you’d want to correct, mainly because if you’re putting additional stress on the shoulder in order to develop power or control during your serve, you need to correct the motion that’s driving that, otherwise you’re going to continue to put unwanted stress on the overall shoulder.

If you’re not getting better with just conservative management, as I’ve described you then should get evaluated by an appropriate physician who has experience in treating and evaluating shoulder injuries. A good history and exam is a good first step. I strongly recommend doing a diagnostic musculoskeletal ultrasound at the bedside while you’re actually being evaluated. And the reason why is cause you can actually look at the rotator cuff tendons at rest and in dynamic motion to see if there’s any stress. You can also see if there’s any instability or impingement on the tendons as well, which can then pretty quickly give you a diagnosis and then give you a set of steps for helping to get better. MRI can be useful as well. In particular, if you need to look deeper at the level of the joint to see if there’s a labral tear or other kind of joint pathology as well.

First-line medical treatment for a shoulder injury in particular rotator cuff injury would be physical therapy, where they work on scapular stabilization, which then leads to progressive strengthening of the muscles around the rotator cuff tendon. That combined with changing, altering and improving your overall serve as well as overhead motions will help in terms of letting you get back to physical activity and playing tennis again.

If you’re not improving adequately with just that next step of medical care, I would then recommend an injection treatment. I don’t recommend steroid injections in general for shoulder issues because it can damage some of the soft tissue. Appropriate other options would include dextrose prolotherapy, platelet-rich plasma, or bone marrow derived stem cells. The keys there are that they should be treating not only the tissue that’s been injured. For example, let’s say the rotator cuff tendon, but they then should be also treating the other soft tissue and other structures that may be implicated in your pain and overall injury pattern as well. So for example, in that prior injury pattern that I described, they should be treating not only the tendon that’s been injured or torn or that’s causing pain, but they should also be treating that were ligaments originally injured leading to instability in the shoulder to begin with.

Lastly, if your injury is too severe, for example if the rotator cuff tendon is fully torn and blown out, surgery would be an important and next step to consider as well. Keep in mind that even after any kind of reparative process and recovery from that injury, if you haven’t fixed what’s actually driving the pain to begin with, the overall movement pattern or the overall generalized weakness that may be driving that, that you will be prone to that kind of injury again unless you fix what was originally causing the problem.

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