ive went to see a physical therapist and he told me that i probably have a labrum tear, i want to know if with therapy can i still have a good baseball career, such as playing in college and things like that
Original Post
Replies sorted oldest to newest
You need to see a specialist. Labrum tears are one of the most difficult sports injuries to correctly diagnose. Even with an MRI, 20% of them show a false negative, meaning nothing shows up on the MRI, but they find a tear when they go in arthroscopically in surgery.
My son just pitched his first innings in competition today in college after labrum surgery last July, so as cneagles19 said, it's not a baseball death sentence.
Good luck!
My son just pitched his first innings in competition today in college after labrum surgery last July, so as cneagles19 said, it's not a baseball death sentence.
Good luck!
A diagnosis of a labral tear doesn't signal the end of a baseball career or even necessarily a need for surgery. In fact, there is wide range of severity of labral tears.
The team orthpedic guy of a MLB team told me that his team does a shoulder and elbow MRI for every incoming pitcher, so they examine players who show no external symptoms of a tear, as well as players who do. He says that "100%" of incoming pitchers have a labral tear and some amount of tearing or scarring of the UCL.
So some pitchers have labral tears, but it causes them no problems, and no treatment at all is indicated.
Other players may benefit from PT, which basically amounts to strengthening the muscles of the shoulder capsule, and that provides support to the joint.
Another group doesn't benefit from PT, but does benefit from changing their throwing mechanics to put less stress on the shoulder.
Some benefit from a combination of PT and mechanics changes.
Still others (typically those with more severe tears) need surgery.
And few simply need (in the words of a different team ortho guy) to "get a girlfriend." In other words, find an interest different than baseball.
So, do you have a tear? If so, which of the above possibilities apply to you? There's no way for posters here to be able to tell you. Follow CPLZ's advice and see a specialist. If at all possible, find your way to a sports (preferably baseball oriented) orthopedic doctor. Such a doctor has a better chance of recognizing a problem with your mechanics, just from the nature of your symptoms.
The team orthpedic guy of a MLB team told me that his team does a shoulder and elbow MRI for every incoming pitcher, so they examine players who show no external symptoms of a tear, as well as players who do. He says that "100%" of incoming pitchers have a labral tear and some amount of tearing or scarring of the UCL.
So some pitchers have labral tears, but it causes them no problems, and no treatment at all is indicated.
Other players may benefit from PT, which basically amounts to strengthening the muscles of the shoulder capsule, and that provides support to the joint.
Another group doesn't benefit from PT, but does benefit from changing their throwing mechanics to put less stress on the shoulder.
Some benefit from a combination of PT and mechanics changes.
Still others (typically those with more severe tears) need surgery.
And few simply need (in the words of a different team ortho guy) to "get a girlfriend." In other words, find an interest different than baseball.
So, do you have a tear? If so, which of the above possibilities apply to you? There's no way for posters here to be able to tell you. Follow CPLZ's advice and see a specialist. If at all possible, find your way to a sports (preferably baseball oriented) orthopedic doctor. Such a doctor has a better chance of recognizing a problem with your mechanics, just from the nature of your symptoms.
quote:Originally posted by 3FingeredGlove:
He says that "100%" of incoming pitchers have a labral tear
Nowhere in dozens of hours of research, and hours of consultations with Orthopedic surgeons, has anyone ever said that a labral tear is 100% diagnosable. From Dr. James Andrews mouth to my ear, only 80% of shoulder labral tears show up on MRI's, and there is no clinical test to diagnose one with any degree of certainty.
I know your statement is qualified with by "incoming pro pitcher", but there have been many examples of false positive labral tears, where athroscopic surgery ruled out any labral tear and found other issues. One was my sons teammate who had surgery the same day and was found not to have a labral tear.
I really wonder what the surgeon you refer to means when he says 100% of incoming pitchers have labral tears? That statement is simply not supported in any of the documentation I have read.
I don't see any particular inconsistency among what you've written and what I've written.
Certainly a labrum tear isn't 100% diagnosable, and that includes diagnosis by arthoscopic examination. However, as the severity of the tear or fraying increases, the likelihood of a correct diagnosis (a true positive) goes up. So the 80% figure for MRI exams (meaning a 20% false negative rate) has an implied threshold level of severity.
The ortho guy says 100% had labrum tears. Even if the diagnosis had perfect accuracy, there is still statistical uncertainty to consider. It the sample population is 50 pitchers, there is a 1/6 chance that the true number of pitchers with labral tears (as hypothetically measured from a much larger sample) is actually 45/50, or 90%.
As for false positives, again that depends on the observed severity. However, I think it is generally true that a false positive diagnosis happens more frequently when a patient has symptoms that need explaining. But because the team is doing MRIs on every pitcher, all of whom were actively pitching at the time, with no apparent injury, the pressure to come up with some kind of diagnosis is reduced.
That's the interesting part: Whether you think "100%" really means 90% or 80%, the majority of incoming MLB pitchers have labral tears. And they are mostly asymptomatic. So the surgeon says that labral tears are common, and the important issue is whether it causes a functional problem.
Of course, most people who have shoulder MRIs do have a functional problem. A diagnosed labral tear may be the sole cause of the problem, or a contributor, or sometimes unrelated.
Certainly a labrum tear isn't 100% diagnosable, and that includes diagnosis by arthoscopic examination. However, as the severity of the tear or fraying increases, the likelihood of a correct diagnosis (a true positive) goes up. So the 80% figure for MRI exams (meaning a 20% false negative rate) has an implied threshold level of severity.
The ortho guy says 100% had labrum tears. Even if the diagnosis had perfect accuracy, there is still statistical uncertainty to consider. It the sample population is 50 pitchers, there is a 1/6 chance that the true number of pitchers with labral tears (as hypothetically measured from a much larger sample) is actually 45/50, or 90%.
As for false positives, again that depends on the observed severity. However, I think it is generally true that a false positive diagnosis happens more frequently when a patient has symptoms that need explaining. But because the team is doing MRIs on every pitcher, all of whom were actively pitching at the time, with no apparent injury, the pressure to come up with some kind of diagnosis is reduced.
That's the interesting part: Whether you think "100%" really means 90% or 80%, the majority of incoming MLB pitchers have labral tears. And they are mostly asymptomatic. So the surgeon says that labral tears are common, and the important issue is whether it causes a functional problem.
Of course, most people who have shoulder MRIs do have a functional problem. A diagnosed labral tear may be the sole cause of the problem, or a contributor, or sometimes unrelated.
quote:Originally posted by smooth ali:
ive went to see a physical therapist and he told me that i probably have a labrum tear, i want to know if with therapy can i still have a good baseball career, such as playing in college and things like that
smooth,
I believe the information provided that a physical therapist cannot diagnose a labral tear is correct.
You should get yourself to a sports orthopedist and preferably one knowledgeable with baseball players.
The diagnosis is one usually made based on the clinical history, clinical findings(clicking in the shoulder, instability, and weakness at at or above shoulder level) and an MRI with contrast(dye).
For many players, the diagnosis is a tough one based on history and clinical exam because they work so hard on range of motion and strength that it might be mistaken, and too often is, for bursitis and/or impingement syndrome.
Certainly, a trial of conservative care can be best, including strengthening, flexibility and the like. It does not heal the tear, but does allow for strengthening to compensate for any tear that might be diagnosed.
If there isn't adequate improvement with conservative care, other treatment options including surgery need to be explored.
Conservative care, strengthening and range of motion for up to 6 weeks is a reasonable period, likely with no throwing, if a tear is suspected for your symptoms. If you get improvement and then the symptoms recur with throwing rehab have it checked immediately.
If you are able to confirm the labral tear, or if it is not confirmed but you are having symptoms, be careful in letting doctors use cortisone injections.
Good luck to you on your efforts to determine the correct diagnosis and treatment and being headed toward recovery.
3FG, as difficult as it can be a for many minor leaguers to get the team to authorize and pay for an MRI when the player is injured and impacted in playing ability, I am both surprised and chagrined to read the news that shoulder and elbow MRIs are routinely given for every MLB pitcher, even those without symptoms or impairment. Interesting implications.
Do you think the rountine MRI is for "diagnostics" or contract mitigation since it isn't for treatment?
quote:The team orthpedic guy of a MLB team told me that his team does a shoulder and elbow MRI for every incoming pitcher, so they examine players who show no external symptoms of a tear, as well as players who do. He says that "100%" of incoming pitchers have a labral tear and some amount of tearing or scarring of the UCL.
I can safely say this team is not the Orioles.
quote:For many players, the diagnosis is a tough one based on history and clinical exam because they work so hard on range of motion and strength that it might be mistaken, and too often is, for bursitis and/or impingement syndrome.
Sounds like my son. He was first diagnosed with an impingement and told to rehab, didn't help. X-rays didn't help, finally given an MRA (MRI with dye) and they still weren't 100% sure what was wrong. During surgery they found his labrum was torn 3/4 of the way thru. Three screws, etc... later and a lost season he's trying to make a team. Time will tell.
smooth ali, as others have stated, see a specialist!
quote:Originally posted by 3FingeredGlove:
However, as the severity of the tear or fraying increases, the likelihood of a correct diagnosis (a true positive) goes up.
I have been told that this is not true. Sometimes very minor tears are easy to diagnose and see on an MRI, while very major ones are false negative on MRI and only evident upon arthroscopy.
quote:Originally posted by 3FingeredGlove:
Certainly a labrum tear isn't 100% diagnosable, and that includes diagnosis by arthoscopic examination.
According to everything I have read, arthroscopy has the highest degree of accuracy of diagnosis, and some papers did refer to it as 100%.
quote:Originally posted by cneagles19:
It is very possible to continue your baseball career- a torn labrum is not a baseball-death sentence. However, depending on the severity of the tear, you may or may not be able to rehab it.
If it does require surgery, you should be able to have a full recovery and be game-ready in 8-10 months.
What he said. My son pitched live action for the first time about 10 months after labrum surgery. At that time he was about 75% of his prior form at best. However, last Wednesday (about 1 yr) he was starting to look like his "old self".
do you pitch? its always worse for a pitcher. atleast if youre a position player and can hit even if its awful and you can never throw right again, you could always play 1B.
I am going to agree on the simple message from backstop. I think you do recover, but pitchers, physically & mentally, may experience drawbacks. Heck, you can bat with bad tear.
Now 9 months post op and the college season has ended. Junior continued to make strides. He hasn't yet fully regained his velocity, but in his last game was low 90's on some.
The only stumbling block once he started pitching regularly, was when he thought he could do without his prescription Naproxen. His shoulder stiffened and pain returned. Within 1 week of restarting his Naproxen regimen, he was pitching pain free, and within two weeks, his arm was fully loose again.
By the end of the season, his pitch count went up to 120 and he said his arm felt great. He had no problems with control (other than a normal pitchers day to day control issues).
His trainer has told him he fully expects him to regain all his velocity back.
Quite honestly, my expectations for recovery, based on all I had researched and heard, were much lower than has been experienced.
To those that are facing Labrum and SLAP surgery, especially power pitchers, I hold out my son as an example of hope for you.
The only stumbling block once he started pitching regularly, was when he thought he could do without his prescription Naproxen. His shoulder stiffened and pain returned. Within 1 week of restarting his Naproxen regimen, he was pitching pain free, and within two weeks, his arm was fully loose again.
By the end of the season, his pitch count went up to 120 and he said his arm felt great. He had no problems with control (other than a normal pitchers day to day control issues).
His trainer has told him he fully expects him to regain all his velocity back.
Quite honestly, my expectations for recovery, based on all I had researched and heard, were much lower than has been experienced.
To those that are facing Labrum and SLAP surgery, especially power pitchers, I hold out my son as an example of hope for you.
Thank you for all your insite! My Son is set to see Dr. Andrews this Monday/Tuesday. Your post have been very helpfull.
I have received a number of emails and pm's on the topic recently, and thought I would share publicly some of what I have shared privately.
My son is one of three of his teammates to undergo SLAP repair at about the same time. He is the only one of the three to make it back so far. He is also the only one of the three to follow his rehab to the T. The others are experiencing stiffness, lack of range of motion and pain. Junior was only home for about 2 weeks immediately post op and then back at West Point. But for those two weeks, he had stretching exercises and isometrics that he had to be doing, and was diligent.
The key to recovery in my mind, is to follow the rehab protocol without deviation. The shoulder will feel good enough to do more, but don't. There are small muscles in the shoulder that if overworked, especially from the standpoint of using too much weight or resistance, will not get worked, because the larger muscles will take over.
At one point in the rehab we had to adjust to throw less frequently. The trainer adjusted the number of throws to be more, but then the rest period between sessions to be longer. In my sons case, this worked out well.
When he first came back, he focused on regaining his velocity and his control suffered greatly. After a couple of weeks, he backed off on velocity in search of his control, which he found rather quickly at the lower speeds. He had been an 89-91 sitting pitcher before surgery, and then he was throwing 3 hit shutouts at 83-84 mph with pinpoint control and good movement. His delivery looked effortless and he told me he felt he could pitch all day like that. As the season progressed, he gradually increased velocity naturally, to the point where last weekend, he was sitting 89-90 and looked comfortable.
Quite honestly, when the surgeon told me that he fully expected my son to recover 100% and pitch at the highest level he was capable of, I was skeptical. It did give me hope however, in that he didn't hedge at all. In hindsight, it appears he was correct.
My son is one of three of his teammates to undergo SLAP repair at about the same time. He is the only one of the three to make it back so far. He is also the only one of the three to follow his rehab to the T. The others are experiencing stiffness, lack of range of motion and pain. Junior was only home for about 2 weeks immediately post op and then back at West Point. But for those two weeks, he had stretching exercises and isometrics that he had to be doing, and was diligent.
The key to recovery in my mind, is to follow the rehab protocol without deviation. The shoulder will feel good enough to do more, but don't. There are small muscles in the shoulder that if overworked, especially from the standpoint of using too much weight or resistance, will not get worked, because the larger muscles will take over.
At one point in the rehab we had to adjust to throw less frequently. The trainer adjusted the number of throws to be more, but then the rest period between sessions to be longer. In my sons case, this worked out well.
When he first came back, he focused on regaining his velocity and his control suffered greatly. After a couple of weeks, he backed off on velocity in search of his control, which he found rather quickly at the lower speeds. He had been an 89-91 sitting pitcher before surgery, and then he was throwing 3 hit shutouts at 83-84 mph with pinpoint control and good movement. His delivery looked effortless and he told me he felt he could pitch all day like that. As the season progressed, he gradually increased velocity naturally, to the point where last weekend, he was sitting 89-90 and looked comfortable.
Quite honestly, when the surgeon told me that he fully expected my son to recover 100% and pitch at the highest level he was capable of, I was skeptical. It did give me hope however, in that he didn't hedge at all. In hindsight, it appears he was correct.
quote:The key to recovery in my mind, is to follow the rehab protocol without deviation
i agree that this is vital to complete recovery.
another thing that's not at the front of these surgery's , the mental aspect. it can get into a players head and be tough to over come. not sure how you shake it.
cplz
congrats on your son's recovery, quite a road ,i'm sure.
CPLZ,
I am extremely happy to be reading the information about your son, his experience, and his recovery to competing this season, at a high level, and at the Regional.
I agree that following the rehab plan concisely and precisely is important, I believe there are many, many keys to recovery.
From my research, the following items are at least as important:
1. The quality and experience of the surgeon doing the labral repair;
2. The extent of damage to the labrum(1 tear or more than 1) and rotator cuff;
3. The location and size of the tear;
4. The quality of the rehab plan:
5. Some luck!!
From what our son experienced, every doctor and therapist, prior to surgery, will express complete optimism that recovery will be 100%. Ours in fact was told by the MLB team orthopedist and training staff that he would be fully recovered and able to play 5 months post surgery. With repeat questioning, he and "we' received strong assurance of complete recovery and the time frames for that recovery.
Our son followed the team required PT plan and throwing rehabilitation program. After many months(far beyond 5 months) he was not improving.
In a study reported by a Phillies team orthopedist in the Spring of 2008, he concluded that about 25% to 30% of the players who are post shoulder surgery recover to their pre-injury level of competition. His analysis called for more attention to this pretty dismal recovery rate.
I completely agree with the idea that hope for complete recovery is critical. For those of our sons who do have such a result, you have to jump for joy.
Unfortunately, to this date, it appears they may be more the exception rather than the rule.
I am extremely happy to be reading the information about your son, his experience, and his recovery to competing this season, at a high level, and at the Regional.
I agree that following the rehab plan concisely and precisely is important, I believe there are many, many keys to recovery.
From my research, the following items are at least as important:
1. The quality and experience of the surgeon doing the labral repair;
2. The extent of damage to the labrum(1 tear or more than 1) and rotator cuff;
3. The location and size of the tear;
4. The quality of the rehab plan:
5. Some luck!!
From what our son experienced, every doctor and therapist, prior to surgery, will express complete optimism that recovery will be 100%. Ours in fact was told by the MLB team orthopedist and training staff that he would be fully recovered and able to play 5 months post surgery. With repeat questioning, he and "we' received strong assurance of complete recovery and the time frames for that recovery.
Our son followed the team required PT plan and throwing rehabilitation program. After many months(far beyond 5 months) he was not improving.
In a study reported by a Phillies team orthopedist in the Spring of 2008, he concluded that about 25% to 30% of the players who are post shoulder surgery recover to their pre-injury level of competition. His analysis called for more attention to this pretty dismal recovery rate.
I completely agree with the idea that hope for complete recovery is critical. For those of our sons who do have such a result, you have to jump for joy.
Unfortunately, to this date, it appears they may be more the exception rather than the rule.
infielddad,
Your analysis and stats are quite sobering. They are consistent with what I've heard all along, and yes, there certainly are a number of contributing factors to the degree of recovery.
I remember the first stat I saw for "power pitchers" recovering fully from labrum surgery (I can't recall the source, only my reaction to the stat), was less than 5%. Talk about taking the wind out of your sails! Further investigation showed more promising statistics, more in line with what you've outlined.
My personal experience with orthopedic surgeons, was that most times they would hedge on recovery (a shoulder twice and a knee twice, both years ago). I was heartened by the surgeons prognosis for sons recovery, although, the reason, as you state, may be attributed to a change in the way doctors approach prognosis these days...from a more positive angle rather than the former negative, CYA angle.
For the record, the surgeon considered Juniors tears to be minor. One requiring one stud, and one requiring one stud and one stitch. I'm sure to some degree, this is a factor in his recovery.
Thanks for both your well wishes and your sharing. I know you have been down this path and your experiences and perspective are invaluable.
Your analysis and stats are quite sobering. They are consistent with what I've heard all along, and yes, there certainly are a number of contributing factors to the degree of recovery.
I remember the first stat I saw for "power pitchers" recovering fully from labrum surgery (I can't recall the source, only my reaction to the stat), was less than 5%. Talk about taking the wind out of your sails! Further investigation showed more promising statistics, more in line with what you've outlined.
My personal experience with orthopedic surgeons, was that most times they would hedge on recovery (a shoulder twice and a knee twice, both years ago). I was heartened by the surgeons prognosis for sons recovery, although, the reason, as you state, may be attributed to a change in the way doctors approach prognosis these days...from a more positive angle rather than the former negative, CYA angle.
For the record, the surgeon considered Juniors tears to be minor. One requiring one stud, and one requiring one stud and one stitch. I'm sure to some degree, this is a factor in his recovery.
Thanks for both your well wishes and your sharing. I know you have been down this path and your experiences and perspective are invaluable.
CPLZ,
I attend to agree with what has been said. Your son's issues tend to be minor and most likely why his prognosis was good, and also his work ethic for proper recovery. He's been really fortunate.
This is why it is so important to report any unusual discomfort, the longer one continues to work through an injury the worse it becomes.
FWIW, 3FG, if you are talking about the draft, not every pitcher coming into milb gets an MRI, only the ones where $$ is a big factor. If the preliminary physical indicates an issue or player has had an issue (for any player)then further tests are done. Most teams draw a line as to who they will MRI and who they will not. FA's most likely get full physicals which do not include MRI.
I attend to agree with what has been said. Your son's issues tend to be minor and most likely why his prognosis was good, and also his work ethic for proper recovery. He's been really fortunate.
This is why it is so important to report any unusual discomfort, the longer one continues to work through an injury the worse it becomes.
FWIW, 3FG, if you are talking about the draft, not every pitcher coming into milb gets an MRI, only the ones where $$ is a big factor. If the preliminary physical indicates an issue or player has had an issue (for any player)then further tests are done. Most teams draw a line as to who they will MRI and who they will not. FA's most likely get full physicals which do not include MRI.
CPLZ you have a PM.
Now 14 months post op and fall ball has begun. Last season, after starting out 1-2 while trying to get velocity back, Junior abandoned the velocity quest in favor of finding his control. He spent the rest of the season with excellent control sitting 85-87 touching 89. He claimed he never tried to heat it up again, because he didn't need to, and he would work on his velocity this fall.
Pitched one inning today, sitting 89-91 touching 93.
Unless there is some future change, this should conclude his road to full recovery from labrum surgery. At this time, control, velocity and endurance have all come back to their previous levels, 100%. My son has been very fortunate.
Pitched one inning today, sitting 89-91 touching 93.
Unless there is some future change, this should conclude his road to full recovery from labrum surgery. At this time, control, velocity and endurance have all come back to their previous levels, 100%. My son has been very fortunate.
Congrats CPLZ that is outstanding!
sounds like he's back with a vengance. great news,it's never easy coming back. even harder to come back 100%.