The cricketer's shoulder: Not a classic throwing shoulder

Objectives: To describe the musculoskeletal adaptations inherent to the cricketers’ shoulder and determine potential predictors of shoulder injury in elite South African cricketers. Design: Prospective longitudinal cohort study; Setting: Non-clinical, at national cricket indoor training venues. Participants: One hundred and six elite cricketers, representing 82% of the South African national and franchise teams, consent. A total of 105 cricketers (27 ± 4 years) were eligible for participation in this study. Main outcome measures: A pre-season shoulder screening battery including a shoulder function questionnaire, two ultrasonographic shoulder measurements and 14 musculoskeletal tests including pain provocation, range of motion, strength and flexibility was assessed. Non-contact dominant shoulder injuries were documented throughout the 2016/2017 season. Results: The musculoskeletal profile of a cricketer's shoulder is described. 17% (95%CI: 9–24%) of cricketers sustained an injury during the 2016/2017 season. Two of the 17 screening tests predicted seasonal dominant shoulder injury (p < 0.05): a dominant supraspinatus tendon thickness ≥5.85 mm (sensitivity: 72%, specificity: 63%) and non-dominant pectoralis minor length ≤12.85 cm (sensitivity: 83%, specificity: 55%). Conclusion: The musculoskeletal adaptations inherent to cricketing shoulders are distinctly different to the classic “thrower's shoulder” described in baseball. A thickened dominant supraspinatus tendon and a shortened non-dominant pectoralis minor muscle are risk factors for developing shoulder injury in this group. This identifies the need to investigate preventative strategies (strengthening/flexibility) and throwing workload management in cricketers with shoulder injury.