Spring is just about here and many athletes will be out playing softball and baseball. What types of injuries are most common in this group of athletes?
Because the motion of throwing is not a natural motion, injuries to the shoulder and elbow tend to head the list of injuries. With each throw, a small amount of trauma is placed upon both of these joints. Over time, injuries occur due to overuse.
What are the most common disorders seen in the shoulder?
Probably the most common injury is a tendinitis of the rotator cuff muscle. Technically the rotator cuff is not a single muscle, but a muscle group made up of four separate muscles, which act to externally rotate and raise the arm. Another injury which is not as common is a tear of the cartilage around the shoulder blade called the labrum.
How are the two disorders different?
Pain in rotator cuff disease is caused and is referred down the deltoid, or outside of the arm. Doing simple things like putting on a shirt, combing the hair, or driving a car can cause significant pain. Some people even have pain at night that keeps them awake. Pain with a torn labrum is more of a deep aching pain that occurs with overhead activities of the arm.
You said that throwing is not a natural motion. What do you mean by that?
The act of throwing any projectile, whether it be a baseball, softball, or rock creates tremendous stress on the ligaments that hold the elbow together as well as the muscles of the shoulder.
How can an athlete protect their shoulder from injury?
Most injuries in throwing athletes tend to develop from overuse. Because of the warm climate in Southern Nevada, many of these athletes participate in baseball related activities on a year round basis. While the exercise and competition is a good thing, it is important for individuals to listen to their body and to back off when appropriate. A proper warm-up period is critical no matter the age of the athlete. Of course the older the athlete, the more crucial the warm-up period time becomes.
Should an athlete try and play through shoulder pain?
It depends on what is causing the pain. There is a saying of: “no pain, no gain.” In the case of shoulder tendonitis; however, playing through the pain can eventually lead to a tear of the muscle. Therefore, it is important to back off activity and let the shoulder heal. Taking time off and allowing muscles to heal can prevent lost time later in a season.
What types of problems can occur with the elbow?
The elbow takes the greatest beating during the throwing motion. Once the arm is cocked back, the next motion to take place is the acceleration phase of the throw. During this point, tremendous amounts of stress are applied to the elbow, especially the inside ligament called the medial collateral ligament (MCL). If enough force is applied, the ligament can tear.
What players tend to have this injury most commonly?
Pitchers are by far the most common players. With the number of throws required to make during innings as well as warm-up throws before games and between innings, a lot of micro-trauma is incurred about the elbow. Outfielders occasionally tear this ligament as well because of the long throws that they are required to make.
What can be done for the MCL if it in fact is torn?
The MCL can be surgically reconstructed if needed. This surgery was first performed by Dr. Frank Jobe, team physician for the LA Dodgers. It has since become well known as “Tommy John surgery,” because it was first performed on the famous Dodger pitcher.
Does everyone that ruptures their MCL need it to be surgically reconstructed?
Absolutely not. According to Mark Schickendantz, M.D., team consultant for the Cleveland Indians, “the only people that need this ligament are overhead throwing athletes.” Therefore, for the average person, reconstruction of the ligament is not usually recommended. For an elite throwing athlete, however, more force can be generated during the throw if this ligament is present.
Can someone still throw without the MCL?
Yes. In fact, there are even a few major league athletes that have ruptured this ligament and never have had surgery to reconstruct it. These athletes have really had to strengthen their wrist flexors, however.
What other disorders can occur at the elbow?
There are several things that can happen. Two common things are tendonitis from overuse, and degenerative changes from the repetitive motion of throwing.
What do you mean by degenerative changes?
This refers to arthritic changes that affect the actual elbow joint secondary to chronic overuse.
After an injury to the shoulder or elbow, how should an overhead throwing athlete strengthen themselves?
Probably the best way to approach this is on a case by case basis. The key thing to keep in mind is that the shoulder, elbow, and wrist all play an important role during the motion of throwing. Because of this, when any of the three are injured, special emphasis should be placed on all three areas with regards to rehabilitation so that when the athlete resumes throwing, there are no weak links in the chain. It is important to have a good therapist and a physician that understands the mechanics of the throwing motion to oversee any type of rehabilitation protocol.
- Jason M. Tarno, D.O., is Board Certified and Fellowship trained in Sports Medicine. Dr. Tarno is an associate of Crovetti Orthopaedics and Sports Medicine.
For further information call: 990-2290.
Or visit us at: www.CrovettiOrtho.com
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