| By Dr. Kenneth Kearns

The shoulder has the greatest range of motion of any joint in the body. A full range of motion is essential to normal shoulder mechanics and a pain-free reproducible tennis stroke. While it’s common for players to hit just a few warm-up shots before a match, stretching and a proper pre-match routine is vital to avoid injury. Failure to implement these warm-ups can result in overuse injuries and is a common reason why players seek medical care.

Tennis players are susceptible to overuse injuries due to the repetitive nature of the game. An un-warmed shoulder is at increased risk to injury, specifically the rotator cuff. The rotator cuff is a confluence of four muscles that surround the shoulder joint, a ball and socket joint, which is stabilized by keeping the humerus (ball) centered on the glenoid (socket). Not stretching or hitting the appropriate number of warm-up shots can lead to rotator cuff dysfunction and superior elevation of the humerus and impingement on the rotator cuff, causing pain and a limited range of motion.

In addition, the overhead serve exerts a significant force on the shoulder. Microtrauma to the posterior shoulder capsule can result from the stress loads associated with the follow-through. The capsule is a thickened band of tissue that surrounds the shoulder joint and adds stability. The posterior capsule is subjected to repetitive high tensile forces that can lead to capsular hypertrophy and contracture. This leads to a loss of shoulder internal rotation, abnormal shoulder mechanics and can result in injury to the labrum (a soft tissue extension of the shoulder socket that adds stability) and/or rotator cuff.

To prevent an overuse injury, a thorough stretching and warm-up routine should be implemented with every match. However, if symptoms are present, the first response is rest, ice and anti-inflammatory medicines, as directed by your doctor. If these treatments fail to relieve the pain, you should consult an orthopaedic surgeon who specializes in the shoulder. Conservative management is usually the first line of treatment and consists of a varied combination of physical therapy, prescription anti-inflammatories and a cortisone injection. Physical therapy will focus on improving range of motion, synchronizing the rotator cuff and shoulder muscles and re-establishing normal shoulder kinematics. If these measures fail, arthroscopic surgery may be necessary to repair a torn labrum or rotator cuff or release a contracted capsule that fails to respond to therapy.

Stretching and warming-up is often overlooked and perceived as a mundane part of tennis. However, imagine taking a rubber band out of the freezer and stretching it to its max while still cold. It will snap. The shoulder functions similarly and needs to be stretched and warmed up in order to avoid overuse injuries and enjoy a pain-free enduring tennis career.

Dr. Kenneth Kearns

<p>Dr. Kenneth Kearns is a board-eligible, fellowship-trained shoulder and elbow surgeon at Orlin &amp; Cohen Orthopedic Group who specializes in arthroscopic surgery, minimally invasive surgery, joint replacement and fracture care. Dr. Kearns is an award-winning researcher who has published and presented extensively in the areas of shoulder and elbow as well as adult reconstruction. An avid athlete who played varsity ice hockey throughout his undergraduate years, Dr. Kearns brings a special affinity to patients who are counting on his expertise to help them return to their active lives. For more information, or to schedule an appointment, call (516) 536-2800, &nbsp;visit <a href="http://www.orlincohen.com" onclick="window.open(this.href,'wwworlincohencom','resizable=no,location=no,menubar=no,scrollbars=no,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false">www.orlincohen.com</a>&nbsp;or scan the QR Code above.</p>