Dead Arm Syndrome



Dead Arm Syndrome

Dead-arm syndrome often refers to pain during the throwing motion that results in decreased velocity. That said, it may also refer to pain experienced by other overhand athletes including tennis players, typically affecting their serves and overhead shots. Injury to any of the bones or soft tissues in the shoulder can cause the symptoms, but it usually involves the rotator cuff tendons or the labrum.

The rotator cuff is a group of four muscles, but the most commonly injured one is the supraspinatus tendon. The labrum is a cartilaginous structure that surrounds the shoulder socket (or glenoid). It functions like the bumper around the pool table to prevent the shoulder from dislocating.

During the throwing motion or serving motion, the shoulder joint experiences extreme forces. Both the labrum and rotator cuff work extremely hard during this motion to stabilize the arm and dissipate the generated forces. An injury to either structure can make it difficult to throw and or serve.

These injuries result from a myriad of causes including the player compensating for existing problems in order to reduce the discomfort that develops in the shoulders as well as repetitive small tears caused by years of throwing baseballs or hitting tennis balls. The end results are injuries that can range from minor strains or tendonitis to complete tears of the labrum or rotator cuff.

Players with these injuries may complain of a decreased velocity when throwing or serving, decreased control, inability to warm up or pain when hitting or throwing. Often times, these patients have weakness when we test the rotator cuff. Another provocative test of the labrum can generate a positive test result as well. Many of these patients won’t have any abnormalities on standard x-rays, so MRIs are used to confirm the diagnosis. Interestingly, several MRI studies have shown that a large percentage of asymptomatic overhand athletes will have varying degrees of labral and rotator cuff pathology. These findings justify the judicious use of non-operative modalities to try to get symptomatic patients better before indicating them for surgery.

Strains are clearly less severe than tears, but can still result in significant missed playing time. Some players get back in a few days, for others, it can take weeks. Initial treatment is rest with progressive stretching and strengthening of the shoulder. Once the pain in the shoulder has subsided, players often progress through a structured throwing or hitting program until they are able to play normally without pain. For players who have failed to respond to conservative treatment, surgery is a viable option. Surgery is performed arthroscopically on an out-patient basis and addresses the pathology encountered at the time of the arthroscopy. In the case of a torn labrum, the labrum is repaired arthroscopically through small poke holes in the skin and the same is done to address rotator cuff tears. While surgery provides very good results, and particularly returns athletes to their previous sports, the good news is that for patients and athletes with dead arm symptoms, rest and rehabilitation will often get them better.