From the pee wee league to the professional Major League Baseball, the sport is as American as apple pie. Stadiums across the country are filled with parents and fans cheering on the home team to success. The wind up, the pitch, the crack of the bat and the race around the bases against the long throw of the ball from far left field, all get fans out of their seats in enthusiastic celebration.
While most baseball players end each game with only minor scrapes and scratches, there are some who experience more significant injuries. The shoulder is particularly susceptible to harm due to its anatomy and the forceful repetition of movement involved in throwing the ball. Pitching injuries are among the most common baseball shoulder injuries.
The shoulder is comprised of three major bones; the humerus (upper arm bone), the scapula (shoulder blade) and the clavicle (collar bone). The shoulder is a type of ball and socket joint. The head of the humerus fits into the socket of the scapula. The socket is known as the glenoid. The labrum is a band of strong, fibrous tissue which surrounds the outer edge of the glenoid. The labrum helps stabilize the shoulder joint. It also is an attachment point for many of the ligaments of the shoulder. This ligament system, known as the shoulder capsule, keeps the head of the humerus centered in the glenoid socket. The shoulder requires strong tendons and muscles to keep it stable. The rotator cuff is made of four muscles which come together to form a covering, or cuff, of tissue around the head of the humerus.
Shoulder pain is a common complaint among baseball players of all ages and leagues, especially pitchers. Pain experienced during the throwing motion interferes with the ability to throw with velocity. This results in a “dead arm” syndrome. The cause of pain is frequently due to injury of the bones or soft tissues of the shoulder.
The act of pitching can be divided into four phases; the wind-up, cocking, acceleration, and deceleration. The unique flexibility of the shoulder joint allows a person to generate speed while throwing. The anatomy of the shoulder joint lets the head of the humerus fit loosely into the socket. The lack of restrictions allows for a range of motion which is necessary for throwing with velocity, however it also relies on relatively weak soft tissue structures for stability. The highly repetitive throwing motion is at the core of most pitching injuries.
Shoulder pain is not always a result of soft tissue damage, and can also come from the bones in the shoulder joint. Younger players who have not reached physical maturity, and whose growth plates are still open, may experience shoulder pain as a result of a fracture at the growth plate. Often referred to as “little leaguer’s shoulder”, this fracture results in a slight separation of the growth plate. Rotator cuff injuries are another common baseball pitcher’s injury due to the highly repetitive overhead throwing motion.
Diagnosing the cause of the shoulder pain can be tricky and starts with a thorough patient exam and history. Did the pain start suddenly or develop gradually over a period of time? What stage of throwing produces the pain? Where is the pain located? What position does the patient play and how long has the player participated in the sport? The physician uses the information gained during the history and exam to determine what type of imaging tests may best help determine the cause of the pain. X-rays examine the bony structures, while MRIs look at the soft tissue structures of the shoulder. If the X-rays appear normal, it may be necessary to have an MRI to look more closely at the soft structures for diagnosis.
Treatment of baseball shoulder injuries is multi-faceted. The best and earliest is recognition and prevention. Coaches should pay close attention to signs of pain in their athletes. In addition to pain, other signs of possible injury include loss of velocity, stamina or a decline in throwing mechanics. Avoid high pitch counts and excessive breaking pitches, such as sliders and curve balls, in young pitchers to reduce the risk of injury.
Ultimately, the goal is the safe return of the athlete to the field of play with restored ability to throw with accuracy and speed. Resting the arm is the initial treatment. In the example of little leaguer’s shoulder, an average resting period of three months with a gradual return to throwing is recommended. Physical therapy may also be prescribed by your physician depending on the diagnosis.
When rest and physical therapy are not sufficient to treat shoulder pain, or if MRI results reveal a soft tissue injury, surgery may be required to repair the damage. Arthroscopic or open surgery may be necessary depending on the location of the injury.
The diagnosis and treatment of baseball shoulder injuries can be challenging. Early recognition is the responsibility of the coaches, athletes and parents. Once identified, the patient should seek treatment from an experienced orthopedic practitioner. With adherence to the proscribed rest, therapy, and surgery, if indicated, most players will eventually return to their beloved sport of choice.