Shoulder pain from tennis is common, with some studies suggesting that up to 50% of tennis players develop shoulder pain. What are the possible causes of tennis shoulder pain, and how do we manage common tennis shoulder injuries?
Tennis shoulder pain: common injuries
Common tennis shoulder injuries include:
Rotator cuff tendonitis
The rotator cuff is a group of four tendons surrounding the shoulder’s ball and socket joint. They provide strength to lift the arm in all directions. However, they also provide stability to the shoulder to firmly hold the ball of the shoulder (head of the humerus) in the socket (glenoid).
Injury to the rotator cuff in tennis usually occurs from repetitive overload leading to bursitis, tendonitis, or tendon tear.
Pain is the most common problem associated with a rotator cuff injury. Generally, pain is located in the shoulder but sometimes radiates to the upper arm and elbow. In tennis, serving is usually the most provocative activity. Weakness often occurs when the tendons are fully torn. However, it is sometimes difficult to know whether the weakness is true weakness from a complete tear or apparent weakness brought on by pain in the shoulder.
SLAP tear
SLAP stands for superior labrum anterior to posterior. A SLAP labral tear occurs at the top of the shoulder joint where the biceps tendon inserts into the labrum. The labrum makes the socket deeper. Tears of the labrum can occur due to trauma, such as a dislocation, or ageing.
In tennis, SLAP tears occur from excessive serving, causing traction on the superior labrum.
Typically, a SLAP tear causes a catching pain sensation in the shoulder, particularly with serving. Pain can radiate into the back of the shoulder. If the biceps tendon is involved, pain can localise to the front of the shoulder.
The examination can often indicate whether you have a shoulder SLAP tear. Specific tests such as the O’Brien or Crank tests are considered good at detecting a SLAP tear. Nevertheless, no one specific test is accurate in diagnosing a SLAP tear.
AC joint degeneration
The acromioclavicular joint is found at the top of the shoulder. It joins the collar bone (clavicle) with the top of the shoulder bone (acromion). Strong ligaments between the collar bone, acromion, and 1st rib keep the joint together.
AC joint arthritis occurs with age as the joint space narrows and the cartilage disappears. In tennis, serving and groundstrokes increase forces on the AC joint, leading to AC joint pain.
Often, patients point to the AC joint as the site of pain. For example, lying on the shoulder at night can be painful. Moreover, moving your arm across your body can recreate the pain. The joint may look swollen and is often tender to the touch. Also, other tests, such as shoulder strength and neck movements, are usually normal.
Long head of biceps tendonitis
The biceps muscle is a large muscle that sits at the front of the arm. Many people think that the biceps only acts on the elbow. However, the muscle and, more specifically, the tendon plays a role in helping the vital rotator cuff tendons in the shoulder.
Two tendons attach the biceps muscle to the shoulder: the ‘long’ head and the ‘short’ head. The long head passes into the shoulder joint through a groove in the arm bone and a hole in the rotator cuff. Finally, it attaches to the top part of the labrum.
Most problems with the long head of the biceps tendon present with pain at the front of the shoulder. In addition, clicking or snapping is common. Also, problems in the long head of the biceps are commonly associated with rotator cuff tendon problems. So, treating the rotator cuff tendon pathology is essential as well.
Assessment of shoulder pain from tennis
Generally, we start by examining shoulder range of motion, rotator cuff strength and stability. We assess the shoulder’s stability by performing various instability tests in the sitting and lying positions. We also stress the AC joint to see if it reproduces shoulder pain.
Investigations are helpful to clarify the specific diagnosis. X-ray of the shoulder demonstrates AC and shoulder joint degeneration. Ultrasound or MRI scan outlines pathology in the rotator cuff tendons. MRI scan outlines cartilage or labral pathology such as a SLAP tear.
Treatment for tennis shoulder pain
The specific treatment is dependent on the cause of shoulder pain. Nevertheless, treatment principles remain the same irrespective of the diagnosis.
Treatment principles for tennis shoulder pain include the following:
- Modify tennis activity. Moderate your tennis until your shoulder feels better. If you have severe pain, you may need to stop altogether.
- Anti-inflammatory medications. We recommend a short course of NSAIDs such as ibuprofen for 2-4 weeks to reduce pain.
- Rehab. Seeing a therapist for supervision of a rehab programme to improve your strength, proprioception, and stability is vital to returning to tennis.
- Injections. Generally, a cortisone injection directed to the pathology effectively reduces pain and assists rehab. Examples include a cortisone shot in the AC joint, subacromial bursa or long head of biceps tendon sheath. Other injectables, such as hyaluronic acid or PRP, can sometimes help.
- Surgery. Surgical treatment should only be reserved for cases that fail rehab and injections.
How to avoid tennis shoulder injuries
Tennis players can avoid shoulder injuries by employing the following principles:
- Warming up correctly
- moderating training and match play
- optimising serving and groundstroke techniques to reduce the load on the shoulder
- Ensuring the tennis racquet is of the correct stiffness, string tension and grip size
- optimising kinetic chain strength, including core and lower leg strength
Final word from sportdoctorlondon about tennis shoulder pain
Tennis shoulder pain is common. You should see a sports doctor experienced in diagnosing and managing common shoulder pathologies in tennis players.
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