It’s no secret that boxers use their hands, arms and shoulders more than any other athlete. Long, high-intensity workouts can put a serious strain on a boxer’s joints and muscles and none more so than the shoulder. When the shoulder muscles become fatigued, the other structures of the shoulder will try to compensate by transferring the stress, which can lead to injury.

Many times, an exhausted fighter will try to throw harder punches to go for the knockdown and to do so will swing the shoulder further back during the wind up. When the shoulder is over extended in one direction then suddenly forced in another direction (toward the opponent) the biomechanical chain is substantially altered and the ligaments and tendons can be damaged.

In other cases, a punch thrown while off balance can alter the proper chain of movement required and lead to an acute (sudden) injury of a ligament or tendon in the shoulder.

The most common boxing shoulder injuries are:

  1. An Injured or Torn Rotator Cuff

 The rotator cuff is the group of tendons surrounding the top of the humerus that allow for mobility of the shoulder and are responsible for three important shoulder movements for boxers:

  • Rotating the upper arm in (internal rotation)
  • Rotating the upper arm out (external rotation)
  • Moving the upper arm away from the body (abduction)

Rotator cuff tendonitis occurs when the rotator cuff muscles are strained and their tendons develop microtears. This is most often caused by overexertion of the shoulder joint and results in pain, weakness, and reduced mobility in the shoulder

Rotator cuff tears can occur either over time or as the result of a sudden traumatic incident. For boxers, these injuries tend to occur as a result of small micro-tears in the rotator cuff that begin to get larger over time. When the shoulder is not given time to properly rest, the tears in the tendons of the rotator cuff are not able to repair themselves which will weaken the entire shoulder.

However, these injuries can also occur suddenly as the result of a missed punch or over rotating of the shoulder. When rotator cuff injuries occur they are immediately followed by pain, weakness, and reduced mobility of the shoulder.

  1. Subacromial Bursitis

This injury is caused by the inflammation of a small sac (bursa) that cushions the shoulder joint and allows the bones of the shoulder to slide smoothly over one another. In most cases, subacromial bursitis is the result of overexertion and lack of adequate rest for the shoulder joint.

  1. A Torn Labrum

The labrum is responsible for shoulder stability as it holds the head of the upper arm bone (humerus) in the shoulder socket. Any tear in the labrum can lead to instability and cause serious problems for boxers as movement of the arm can cause the shoulder to slip partially or completely out of the socket (dislocation). Typically tears can occur in the back of the shoulder at the posterior labrum as the shoulder is repetitively loaded with each punch.

Treating an Injured Shoulder

As with many athletes, boxers are often hesitant to seek treatment for shoulder injuries because it typically means taking time away from training. Because of this, many boxers attempt to “fight through the pain” in hopes that the injury will resolve itself. However, this is the worst thing a fighter can do as this continues the progression of the injury and injuries that could have been treated non-surgically may then require a surgical procedure to correct.

What Boxers Should Do If They Have an Injury

The first and most important step is consulting an Orthopedic Surgeon to examine and diagnose your specific injury. Based on your injury, the Orthopedic Surgeon can create a treatment plan based on your goals and lifestyle. In many cases, shoulder injuries can be treated with a combination of physical therapy and non-surgical therapeutic injections.

In the rare instances where shoulder surgery is recommended, advancements in arthroscopic surgical procedures have drastically reduced recovery time and can get you back to training faster than traditional procedures.


Dr. Charles Ruotolo is a renowned shoulder expert and the President of Total Orthopedics and Sports Medicine in Long Island.  He has published several clinical papers on shoulder injuries in overhand athletes, including Loss of Total Arc of Motion in Collegiate Baseball Players and “Shoulder Pain and the Overhand Athlete“.  Dr. Ruotolo and the team at Total Orthopedics and Sports Medicine are experts in treating athletes of all levels using a range of options from Physical Therapy to Arthroscopic Surgery.  If you are experiencing shoulder pain, or any muscle or joint injury, contact us today to schedule an appointment in one of our 6 locations in Long Island, Manhattan and the Bronx.