“Dead Arm Syndrome” in Tennis Players
“Dead Arm Syndrome” often refers to pain during the throwing motion that results in decreased velocity. That said, it may also refer to the 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 joint 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 one most commonly injured is the supraspinatus tendon. The labrum is a cartilaginous structure that surrounds the shoulder socket (or glenoid). It functions like the bumper around a pool table to prevent the shoulder from dislocating.
During the 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 serve.
These injuries result from a myriad of causes, including the player compensating for existing problems in order to reduce discomfort that develop in the shoulders as well as repetitive small tears caused by years of hitting tennis balls. The end results are injuries that can range from minor strains or tendonitis to complete tears.
Players with these injuries may complain of decreased velocity when serving, decreased control, inability to warm up or pain when hitting. Oftentimes, these patients will have weakness when we test their rotator cuff, and other provocative tests of the labrum can generate a positive test result.
Most 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 tennis players 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 subjecting them to 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 hitting program until they are able to play normally without pain. For players who fail to respond to conservative treatment, surgery is a viable option. Always consult with your physician for the best course of treatment and before returning to play after an injury.
As the long tennis season starts to wind down, it won’t be uncommon for players of all levels to start experiencing some shoulder pain. The good news is that with some rest and rehabilitation, most of those affected will get back to playing without missing much time.
Dr. David Dines is an orthopedic surgeon at Hospital for Special Surgery. He serves as the medical director of the Association of Tennis Professionals (ATP Tour), the team physician for the US Davis Cup tennis team and an orthopedic consultant for the US Open Tennis Tournament.
Dr. Joshua Dines is an orthopedic surgeon and member of the Sports Medicine and Shoulder Service at Hospital for Special Surgery. He serves as a team physician for the US Davis Cup tennis team.