Confusing Shoulder Pain

Hello people of HSBaseballForum,

I have had persisting shoulder pain for roughly 7 months now and it is demoralizing. I feel I should be performing at a much higher level than I currently am and that simple thought irritates me beyond belief. I have a pain towards the front of my shoulder before I rotate my arm fully to throw the baseball (after external rotation but before internal rotation). Originally I thought the pain simply came from shoulder tightness so I went to a doctor to have the issue cleared. The first doctor believed I had bursitis and the second doctor thought my shoulder was in well repair but hypermobile and weak. As waiting should have cured the bursitis, and I followed a rigorous rehab routine in an effort to be ready for the upcoming spring season, I have no reason to be unable to perform right now. This whole situation infuriates me beyond belief. As I am unable to play, I am getting a third opinion on my shoulder and considering going into surgery. The thing that confuses me is that my MRI(with contrast) came back negative for a labrum tear. RIght now, I feel the current diagnosis by the third doctor may be a labrum injury or bursitis which would require surgery. I am at a crossroads right now and I feel that I am drowning. If anyone has any insight I would appreciate it

Stats:
Height: 6’1
Weight: 145
Age: 15 (Sophomore)
Baseball Level: Majors (Select Baseball)

Original Post

I cannot assist either, but others I'm sure will join in.  Just wanted to throw in, that you're 15, very young and plenty of time to get better and still accomplish your goals.  I'm sure it's frustrating, but don't get too down.

I will add that I know of kids who have had shoulder pain, that was purely growth related.  As a pitcher, if you're not working all areas of the shoulder, through exercise, you will strain the under-worked muscles.  Ask this of your Dr, before going under the knife...too darn young for that!

My son had issues with his shoulder at the beginning of last spring with his college team.  Have you been doing a lot of winter lifting?   The baseball team had worked with a football/hockey trainer over the previous winter and he had them doing some lifting that ended up being "not pitcher friendly".  His shoulder was just "tight" from the type of lifting he had done all winter.  They gave him some specific stretches to do before throwing...and told him to stop doing a couple of the lifts....and the issue went away fairly quickly. 

My only recommendation, if you are not already doing so, is to make sure you are seeing a reputable sports ortho. We always have our players see a team PT. If he refers out, we always recommend one of two reputable sports ortho's. We tell our players to avoid family doctors because they are jack of all trades and do not specialize in sports injuries. Hope you find out what is going on and wishing you a speedy recovery!

Ask about Thoracic Outlet Compression Syndrome, TOS. or nerve impingement...

This will give you a little bit of info. http://www.hopkinsmedicine.org...outlet_syndrome.htm

One of the best shoulder orthopedics in the country is Dr. Chris Ahmad, who works with NY Yankees...I'd imagine that he would review your mri & any other relevent tests . 

Don't mess around with this "nag"!

Good luck & keep the forum posted! 

baseballmom posted:

Ask about Thoracic Outlet Compression Syndrome, TOS. or nerve impingement...

This will give you a little bit of info. http://www.hopkinsmedicine.org...outlet_syndrome.htm

One of the best shoulder orthopedics in the country is Dr. Chris Ahmad, who works with NY Yankees...I'd imagine that he would review your mri & any other relevent tests . 

Don't mess around with this "nag"!

Good luck & keep the forum posted! 

I find your post extremely interesting, first and foremost thank you for your contribution. Secondly, I am based in Dallas would you consider Dr. Chris Ahmad to be worth the flight? I feel if I am a going out of state I might as well see Dr. James Andrews and receive the best care possible. At this stage I am keeping an open mind to all options. My parents have made an appointment with the current ortho for the Dallas Stars (appt day 2/18) as they didn't like the ortho for the Rangers.

JCG posted:

I had bursitis in my shoulder and a cortisone injection cured it almost instantly.  Good luck. 

I too had a cortisone shot for bursitis but it was ineffective at this point sugery may be the best option but I am still hesitant as I am only 15. Gladly though you had a speedy recovery.

iplaybaseballtoo posted:
baseballmom posted:

Ask about Thoracic Outlet Compression Syndrome, TOS. or nerve impingement...

This will give you a little bit of info. http://www.hopkinsmedicine.org...outlet_syndrome.htm

One of the best shoulder orthopedics in the country is Dr. Chris Ahmad, who works with NY Yankees...I'd imagine that he would review your mri & any other relevent tests . 

Don't mess around with this "nag"!

Good luck & keep the forum posted! 

I find your post extremely interesting, first and foremost thank you for your contribution. Secondly, I am based in Dallas would you consider Dr. Chris Ahmad to be worth the flight? I feel if I am a going out of state I might as well see Dr. James Andrews and receive the best care possible. At this stage I am keeping an open mind to all options. My parents have made an appointment with the current ortho for the Dallas Stars (appt day 2/18) as they didn't like the ortho for the Rangers.

My son went to Dr Kremcheck, the ortho for the Reds.  I guess I would wonder why they didn't like the guy from the Rangers?  I looked it up, his company has been with the Rangers since 2004.  I'd think if he's respected enough to be the guy dealing with the Rangers during the time that Nolan Ryan (who knows a bit about pitching) was CEO, he's probably good enough for my 15 year old son     I mentioned earlier about the lifting.  The trainer that had my son doing "non pitcher friendly" lifting was a hockey guy and the lifting he had them doing was causing issues.  I know an ortho is an ortho as far as training, but I'd probably prefer go to a "baseball guy" over a "hockey guy" if I'm having pitching arm issues.    I'm also curious...that you did 7 months of rehab.  Based on what?  Two doctors (including one that did an MRI) found nothing wrong, so how did they present any rehab that they thought would fix a problem that didn't exist?   Hopefully they missed something that can be taken care of....but also hope that the 7 months of whatever they had you doing hasn't done more damage that was you originally had

I hate that you're having to go through this but I'm all too familiar with shoulder issues in dealing with my son's labrum tear and surgery. You can read about his continuing saga here if you're interested, and have some time. It details his journey, with periodic updates, and has a lot of good info/advice from others.

As far as what advice I can provide you, having so recently been involved with it myself, is to get multiple opinions from reputable ortho docs before making any decisions about what to do. My son's tear did not show up on the first MRI so he did rest and PT for about two months after. When he ramped back up, the pain returned almost immediately so we had another scan done, which revealed the small tear, among other "housecleaning" issues. The fact is, if you decide to have surgery the surgeon won't really know what's going on until he or she gets inside. My son's tear was actually slightly larger than they expected and there was other fraying/damage that was cleaned up as well. The decision to have the surgery was his alone (with our support of course) and based on risk vs reward as outlined by the surgeon. it boiled down to him simply not being ready to hang up the cleats until he's sure there is no other option. Important to note that he is around two years older than you so there are some variables and decision-points that will differ.

I would encourage you to really think hard if surgery is recommended. This is not a procedure and recovery process that will be easy. It is extremely painful (early on), debilitating, and can be the cause of serious depression if you're not 100% committed to the process and surrounded by support and love. I'm not trying to discourage you from going down that path, I just want you to go into it with eyes wide open. Best of luck and please feel free to PM me if you have any more specific questions about it that you think I might be able to help with.

Buckeye 2015 posted:
iplaybaseballtoo posted:
baseballmom posted:

Ask about Thoracic Outlet Compression Syndrome, TOS. or nerve impingement...

This will give you a little bit of info. http://www.hopkinsmedicine.org...outlet_syndrome.htm

One of the best shoulder orthopedics in the country is Dr. Chris Ahmad, who works with NY Yankees...I'd imagine that he would review your mri & any other relevent tests . 

Don't mess around with this "nag"!

Good luck & keep the forum posted! 

I find your post extremely interesting, first and foremost thank you for your contribution. Secondly, I am based in Dallas would you consider Dr. Chris Ahmad to be worth the flight? I feel if I am a going out of state I might as well see Dr. James Andrews and receive the best care possible. At this stage I am keeping an open mind to all options. My parents have made an appointment with the current ortho for the Dallas Stars (appt day 2/18) as they didn't like the ortho for the Rangers.

My son went to Dr Kremcheck, the ortho for the Reds.  I guess I would wonder why they didn't like the guy from the Rangers?  I looked it up, his company has been with the Rangers since 2004.  I'd think if he's respected enough to be the guy dealing with the Rangers during the time that Nolan Ryan (who knows a bit about pitching) was CEO, he's probably good enough for my 15 year old son     I mentioned earlier about the lifting.  The trainer that had my son doing "non pitcher friendly" lifting was a hockey guy and the lifting he had them doing was causing issues.  I know an ortho is an ortho as far as training, but I'd probably prefer go to a "baseball guy" over a "hockey guy" if I'm having pitching arm issues.    I'm also curious...that you did 7 months of rehab.  Based on what?  Two doctors (including one that did an MRI) found nothing wrong, so how did they present any rehab that they thought would fix a problem that didn't exist?   Hopefully they missed something that can be taken care of....but also hope that the 7 months of whatever they had you doing hasn't done more damage that was you originally had

Exactly, for some reason my parents are against the idea of going to the Rangers doctor because they "didn't like his staff that answered the phone", but rather they would go to the doctor for the Dallas Stars(hockey team) because they "trust him more" and he operated on my dad. Also to clarify I have not done therapy for 7 months (I was injured for 7 months). I have done therapy for about 2 months.

iplaybaseballtoo posted:
baseballmom posted:

Ask about Thoracic Outlet Compression Syndrome, TOS. or nerve impingement...

This will give you a little bit of info. http://www.hopkinsmedicine.org...outlet_syndrome.htm

One of the best shoulder orthopedics in the country is Dr. Chris Ahmad, who works with NY Yankees...I'd imagine that he would review your mri & any other relevent tests . 

Don't mess around with this "nag"!

Good luck & keep the forum posted! 

I find your post extremely interesting, first and foremost thank you for your contribution. Secondly, I am based in Dallas would you consider Dr. Chris Ahmad to be worth the flight? I feel if I am a going out of state I might as well see Dr. James Andrews and receive the best care possible. At this stage I am keeping an open mind to all options. My parents have made an appointment with the current ortho for the Dallas Stars (appt day 2/18) as they didn't like the ortho for the Rangers.

Dr. Keith Meister in Arlington is very good.  He was the Rangers ortho at one time. Not sure if he still is.  

Who prescribed the "rigorous rehab routine"? That makes NO sense from what you explained from MRI...Why would you have surgery if there is no tear? No such thing as exploratory! So, get that "surgery" idea out of your head.... Are you taking lessons? Are you following a "football workout"? 

So, to your issue...Before you fly off to NY, I'd recommend you see a shoulder specialist there in DFW... (was dad's surgery shoulder or elbow?...baseball related?)

1. Keith Meister is excellent! Son rehabbing thru his facility currently. "Staff personality" is not important when you are getting the best medical care available from a Baseball Doctor! https://www.star-telegram.com/...article19560984.html

2. John Conway, at Ben Hogan Center, (trained under Dr Andrews) is also excellent.  

Consult & send them your MRI. Then see what either of these recommend before consulting with Dr Ahmad.

IF TOS is an issue, the best vascular guy is Greg Pearl in Dallas. 

In addition to what other have offered for advise: 

-Find a PT / doc that fully understands hyper mobility , not all do

-make sure they do a simple test for GIRD - can look up on net

-ONLY pay attention to what a Baseball Ortho tells you

This advise is based on my experience with my son. He is hyper mobile and luckily works with a PT who understands what's normal for hyper mobile athletes and whats not......big difference

Good Luck

baseballmom posted:

Who prescribed the "rigorous rehab routine"? That makes NO sense from what you explained from MRI...Why would you have surgery if there is no tear? No such thing as exploratory! So, get that "surgery" idea out of your head.... Are you taking lessons? Are you following a "football workout"? 

So, to your issue...Before you fly off to NY, I'd recommend you see a shoulder specialist there in DFW... (was dad's surgery shoulder or elbow?...baseball related?)

1. Keith Meister is excellent! Son rehabbing thru his facility currently. "Staff personality" is not important when you are getting the best medical care available from a Baseball Doctor! https://www.star-telegram.com/...article19560984.html

2. John Conway, at Ben Hogan Center, (trained under Dr Andrews) is also excellent.  

Consult & send them your MRI. Then see what either of these recommend before consulting with Dr Ahmad.

IF TOS is an issue, the best vascular guy is Greg Pearl in Dallas. 

Actually, there is such a thing as exploratory.  The arthrogram can detect labrum tears, but it also misses some slight tears (according to my son's ortho who was former Nationals team ortho...and now works with the Wizards). With that said, I wouldn't be rushing under the knife without exploring all other options first.

As for cortisone...most doctors (I have talked to) are really hesitant to give that to younger patients because of the damage it can do to other soft tissue.  My younger son has a labrum impingement issue in his hip (not torn) and his ortho said there is zero chance he would use cortisone on him to treat it (and my son just turned 18).

Something you might want to have checked out is your scapular alignment/function.  Oddly enough, if your scapulas (shoulder blades) aren't moving properly it puts a lot of strain on your shoulder and can cause issues.  Your ortho, or a PT should be able to take a look and let you know pretty quickly if things look good back there.

Good luck, I hope you are able to get back out there soon.

I'm sure your ortho doc will take care of this but I thought I'd mention it since my son's was initially ordered incorrectly. If you do plan to have another MRI done, you need to have the arthrogram ordered to detect a labral tear, not an MRI with contrast as you mentioned above. The former injects the contrast directly into the joint whereas the latter goes into a vein. Best of luck!

Baseball2,

Sorry to hear of your pain and struggles.  The shoulder is a morass, and not an easy diagnosis or fix.  RHP son had some shoulder pain last year of HS baseball, and in that last year of pitching wide swings in command.  Played summer collegiate wood bat league as a rising freshman and lasted two horrible outings where throwing a strike was impossible due to the pain at point of release.

Went to PT who put hands on and felt it was just "fatigue."  His college PC shut him down and sent him home.

Our hometown Ortho did X-ray.  "Negative.  It's fatigue," he said.

Pain continued at home home.  Had hometown Ortho take MRI.  "Negative."

Off to summer school and summer workouts, pain still there.  Team Trainer and Team Doc put him on anti-inflammatories, and more PT.

Pain now worse than ever, now late September of freshman fall season.

Team Doc did 2nd MRI with arm in different position.  MAJOR LABRUM TEAR.

My point is that getting a verifiable, definitive diagnosis is surprisingly hard for the shoulder.  I think 9and7 (poster on here) would agree.   A lot of players have labrum tears they "live with."  Some can do that, depending on how much a tear it is apparently.  I'm  not an expert.  Just the dad of a RHP who is going through it. 

Son had surgery on shoulder mid-October and will be out 12-18 months.  Not the start to his college career he envisioned.  

So, keep getting opinions.  Make sure the shoulder is in a position for the MRI where the pain area can be seen.  Again, talk to the docs about this and make sure the techs the day of the MRI allow you to move your arm to the position it needs to be in to be thoroughly read (son had to stop his second MRI and call the ortho as the techs weren't getting the position son felt he needed to make the 2nd MRI legit).  I am not giving medical advice.  Just keep exploring.  If the pain is there, then something must be there causing it.  

Good luck.

Since I've been mentioned (haha), I'll add my uneducated opinion.  I think it's very important with a shoulder injury to be seen by an ortho with appreciable experience with THROWING athletes.  Not just professional athletes in other sports, but throwing athletes.  It wasn't until mine was seen by a doctor who understood baseball players that he got the care he needed.  Even then the diagnosis was tricky.  My experience is it's a very long road back from a shoulder issue.  Just my opinion.

Man, I wish overhead throwing was a natural action for humans!!

My son came home from a workout last night and said "I think I have an addiction problem to baseball, I don't ever want it to end"  These injuries can be crushing to a young man.  Here's to them coming out stronger on the other side of it!

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