Labrum Questions

He needs an MRI, no guessing.  Then you can move forward.

Do not let him pitch until you know what's going on!

Why did he not have an MRI sooner?  

playball2011 posted:

Why did he not have an MRI sooner?  

Doctor said whether the MRI showed a Labrum tear, or a minor tear, his treatment would be the same.  He did not recommend surgery because after surgery it usually tightens up and the VELO and arm is never the same again.  He said no matter what the MRI showed, he was going to suggest lots of therapy.  He said lots of guys suffer from torn labrums and end up going to therapy and strengthening it and are fine afterwards.  He said surgery was a last resort.  Went to two different doctors and both said the same exact thing.  Both examined him, his Range of Motion, stability, etc. and both said "Labrum".  Whether the MRI showed a complete tear or a minor tear, both their treatments were lots of therapy and only surgery as a last resort.  

Two sports injury doctors said this? Both were shoulder specialists?  Were they in the same practice? Wow! Not exactly what I heard when we talked with doctors and PT's for our youngest son. Yes, generally surgery is the last resort. Yes many (if not most) pitchers have some sort of labrum tear or "fraying". The push to PT is to make sure the throwing motion is OK, the shoulder is "in tact" and "whole", etc.  The sports related PT's are miracle workers as sometimes there's just some impingement that somehow they magically can work out. Sometimes a PT spots something related to the shoulder position that's not the same in the non throwing shoulder (there's an amount of laxity they look for).  There are certain exercises that can be done in order to help.  This is something another son went through when he "popped" his shoulder while throwing a pitch (think cracking your knuckles, but done while throwing a pitch - yes, very painful). I believe the "theory" behind the rest is that the minor tears will then develop scar tissue.  That scar tissue helps "bind" the area a bit more (e.g. stiffness).  PT done after that rest will be similar to any post surgery PT.

As for why no MRI - well that probably comes from years of dealing with insurance companies who balk at getting an MRI before other options are exhausted.  Think of it this way - 10 PT appointments cost you the copay and time. It's also I believe less expensive than one MRI. Do a little scouting in here and you'll find that when you do get that MRI, make sure the orders come with "contrast dye" - very important. Keep pushing/asking for it - be very persistent. It's a difficult area to MRI. Consider how a tear looks, when it would show up, then think of how one must lie still in an MRI machine.  My son's MRI's didn't show anything significant, but surgery proved a 90% tear in the posterior labrum.  Expect a long recovery too - we are in month 4 now...  Expect numerous trips to PT.

With regard to "tightness" and VELO change...  As I learned when talking with the PTs - a goal of PT is to find the right balance between breaking up the scar tissue (e.g some of the source of tightness), but not so much that the shoulder has too much laxity.  That ends up being the other problem...  It's a[n excrutiatingly] slow process. With regard to VELO dropping - neither doctor we saw used those exact words. If the surgery goes well and the PT is done properly, then it's likely to have the same as before.  Remember it's not just *any* PT, it's one that regularly deals with sports injuries. We've been very fortunate to know people in the business and see the right people.  I'm more happy that my son will be able to pick up something "long term" rather than the "short term" of being able to pitch again.  Yes, not being able to compete senior year HS when you have a good shot at going deep in the playoffs is a bummer, but not being able to pick up stuff, open doors, throw with his children, etc. long term is far worse.

Regardless, the doctor needed an MRI to see what's actually going on.

If it was a small tear it could have been cleaned up.  Obviously the PT didn't work.

Now your son really has no choice. Get the MRI.

Full disclosure, my son had hip labral tears.  Both hips.

The protocol seems to be the same however.  Try PT for 8-10 weeks and see how it goes before MRI.  This is probably insurance dictated to cover the MRI costs by trying lower cost options first.  Keewartson's surgeon said it was messy when he got in there and cleaned up the fraying and then got the full tune up to his hips, one month apart .  

The hip pain was something that he dealt with for years.  He knew the exercises to do for hip impingement (not sure if he did them regularly or only when there was pain), but surgery isn't warranted (paid for by insurance) until there is a tear.  Shoulders may be different?

Find the best surgeon in your area for shoulders.  Make sure the PT is an expert in shoulders.  It was a relief to find out that his physical therapist (in a city different than the surgery) wound up being THE hip guy in our area.

Good luck.  Please post back so that others in a similar situation can follow.

Hers is my .02 worth....my son is coming off of a labrum surgery almost 1 yr to the date,  GET A CONTRASTING MRI.  He had one within days and it revealed a small tear/separation.  He was on the table about a week later with the Dr's expectation of a full recovery.  After all the PT and workouts was fully cleared to throw around the end of his JuCo's fall season.  So, he is now a cpl of months into full throwing and is about 2 - 4 mph off of where he was before.  Personally, I think his biggest hang up right now is the mental side of the recovery to be able to trust letting it go.  Their team has a pre-season series this weekend and he will get a start.  So my advice is to get the contrasting MRI, get in front of it now instead of letting it linger and find a highly qualified shoulder specialist.  Good luck to him and speedy recovery

Hello PitcherOnlyDad...I can relate with you and feel for you. My S had a slap tear couple of years ago, went to 1st dr (sports medicine) and examined, said 'bruised' biceps, to rest. Pain continued, and I requested MRI, and he agreed and we did the MRI with contrast (arthrogram) which is the only way to really see well the results. Turns out there was a slap (close to type 1) and the guy (dr) wanted to operate. I wanted a second opinion and went to a 'baseball' sports medicine dr. He said that S did not need surgery, that he has seen a lot of BB players and a lot has some kind of tear in the labrum ( this guy is the md for an MLB team as well as a power D1 school). He recommended PT at a 'baseball' PT place with therapist that know baseball. The PT guy was incredible although it took 24 hard working sessions to strengthen all the muscles around the labrum so that everything works in perfect harmony. Although S is not a pitcher, he recovered extremely well following all procedure, only missed the fall of his junior year. Now he is a freshman at a D1 school and throws 90+ in the infield (he is a ss). Absolutely no pain whatsoever after the PT and the shoulder is incredibly strong. 

My take...I am a firm believer in PT if done properly by the right people and if the right physician examines your son, a guy that truly understands baseball players and deals with them on the daily basis. A note...after the first 12 PT sessions we went back to dr and we felt that S was not ready and requested another 12 PT sessions (an insurance thing, 12 and then ask for another 12). Each session of S was 2.30 hrs, but it worked. Son was even allowed to work out with the exception of over the shoulder exercises. PT for the kids may be very boring but it really works.

A question for those that have gone through the injury and the PT.  If you had done the PT work continually, as part of a regular conditioning program (on your own), prior to the injury, do you think you would have experienced the injury?

2FORU...IMHO I do believe in PT. In fact, I am of the opinion that if PT exercises are incorporated in players' normal conditioning, that we would see a decrease in injuries (shoulders, arms, etc.). PT is about getting all the muscles of the 'system' (let's say the shoulder) to work together during repetitive actions (e.g. pitching, throwing). By working together all muscles and joints distribute the effort for maximum performance whereby all soft tissues involved work in a 'symphony'. The PT is sort of a guide equivalent to developing muscle memory, except that all soft tissues are involved, and this reinforces all the parts involved; so basically, when a player throws a ball, the whole shoulder has been thought to work together. Injuries occur when one of the components of the shoulder orchestra components in the symphony is not 'in-tune' with the others and works less or more, after a while, something yields and an injury occurs.

So I do believe that PT before can be helpful, however, PT can also be expensive and insurance will not cover to do 'preventive' so it is left to us to figure it out. In my S case, each session was about $1250, mind you that it was a 'prescription' that was approved by insurance and we had to do two 12-sessions to get it fixed. Solution?...I think that there are very good trainers out there that even though they are not PT per se, that they can help a baseball program  and may provide an alternative to high $s. In S's team, they have many people involved in trying to prevent injuries, from the team physicians, to the trainers and PT personnel at the gym and school clinic. However, we are not talking about once kids get to college, but when they are in HS (or before), and you all know HS baseball in general (as well as travel ball) and the facilities and precautions that a coach is going to take are minimal due to how many kids he's got in the pipeline and the resources ($s). So it is up to us to try to accommodate this PT type of exercise to prevent future injuries whether we do it by ourselves or as part of a program. My S does the PT exercises he learned once a week even now just to keep the orchestra in-tune.

FourBases posted:

2FORU...IMHO I do believe in PT. In fact, I am of the opinion that if PT exercises are incorporated in players' normal conditioning, that we would see a decrease in injuries (shoulders, arms, etc.). PT is about getting all the muscles of the 'system' (let's say the shoulder) to work together during repetitive actions (e.g. pitching, throwing). By working together all muscles and joints distribute the effort for maximum performance whereby all soft tissues involved work in a 'symphony'. The PT is sort of a guide equivalent to developing muscle memory, except that all soft tissues are involved, and this reinforces all the parts involved; so basically, when a player throws a ball, the whole shoulder has been thought to work together. Injuries occur when one of the components of the shoulder orchestra components in the symphony is not 'in-tune' with the others and works less or more, after a while, something yields and an injury occurs.

So I do believe that PT before can be helpful, however, PT can also be expensive and insurance will not cover to do 'preventive' so it is left to us to figure it out. In my S case, each session was about $1250, mind you that it was a 'prescription' that was approved by insurance and we had to do two 12-sessions to get it fixed. Solution?...I think that there are very good trainers out there that even though they are not PT per se, that they can help a baseball program  and may provide an alternative to high $s. In S's team, they have many people involved in trying to prevent injuries, from the team physicians, to the trainers and PT personnel at the gym and school clinic. However, we are not talking about once kids get to college, but when they are in HS (or before), and you all know HS baseball in general (as well as travel ball) and the facilities and precautions that a coach is going to take are minimal due to how many kids he's got in the pipeline and the resources ($s). So it is up to us to try to accommodate this PT type of exercise to prevent future injuries whether we do it by ourselves or as part of a program. My S does the PT exercises he learned once a week even now just to keep the orchestra in-tune.

Good stuff. After my son had surgery, he was given a series of exercises to do in his work outs, as well as some before and some after he threw.   I do believe that most top tier college programs as well as all ml teams now incorporate similar type of exercises as a routine for their pitchers.    Its all about practicing prevention.

There are many private trainers out there that are physical therapists as well.  They are expensive to work with but well worth the education that they provide.

Anyway, son isn't pitching right now, but before his gym workouts he does the same routine he has been doing forever.  

Although he has had some issues, I believe that incorporating these exercises prevented any really serious shoulder problems after they discovered he had cortacoid impingement.

Now that the whole process is over, I figured I would come back and share what we experienced with our son so that future posters may can read this and answer their questions.  After posting questions about the labrum and our son's symptoms, I took the advice I received here (as I usually do) and scheduled an MRI on son's shoulder involving the dye injection.  What the doctor found was a partially torn labrum, lots of inflammation and fluid built up, and bursitis.  We were sent to physical therapy and after a few weeks son was cleared to begin a throwing program.  The program was very slow (SLOW) and took awhile to complete.  Just recently, son has been released to pitch again and he has already made 2 starts (on a very strict pitch count) this season.  Son says his arm feels good but that he notices three key differences now then before the injury: 1.) He says it takes him way longer to get loose now before the games (probably more to do with the fact he's just now pitching after 8 months).  2.)  That it takes longer for his arm to recover after pitching (once again probably due to the fact it's not in mid-season shape).  3.)  His velo is down.  

Son is a sidearm/submarine pitcher so he was never really strong in the velo department (low 80's) but as long as he is (6'5 very lanky) it also seemed to be faster.  Now he is only sitting mid 70's (my guess 75) but even without the velo has yet to give up a run thus far this season (knock on wood) and has been primarily relying on his movement and offspeed to get hitters out.  Hopefully, his velo will return with time, but even if it doesn't, son feels extremely blessed to be able to play the game he loves again.  Thanks for all the great advice I received here.  This could have been a completely different story if we did not go get the MRI.  Love the Hsbaseballweb!