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Can anyone relate your experiences regarding LL shoulder diagnosis (proximal humeral growth plate issues). Specifically, how long was rest (no throwing) prescribed, when did rehab (strengthening exercises) start, when was throwing restarted, and how long was it before player was cleared to play. 14 yo RHP/1B/OF - his growth plates are maturing quite a bit slower than the norm, based on a sport ortho Dr's opinion.
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TR - no kidding? Can't help the sarcasm, but my post was asking about about other's experiences to better understand the range of rehab optionsm, not self-diagnose or prescribe.

BOF - Thanks, I have already ordered these.

CADad - Have been waiting for results of second opinion before replying. And the answer is: Sick Scapula Syndrom or gleno-humeral internal rotation deficit, or GIRD.

No growth plate separation or fracture. I was skeptical of the LL shoulder diagnosis; turns out the right shoulder growth plate was not different from the left on x-ray. First Dr did not even x-ray left shoulder for comparison - just an off-the-shelf "LL shoulder, take 2 advil, and see your PT in the morning" diagnosis!

Prescription now is 2-4 wks no throwing, Keebler (sp?)exercises to start, with PT incorporating Jobe exercises and core work. Setting back start of son's season (i.e., pitching)~ 6 wks pending successful strenghtening and reduction in scapula displacement.
Scapula displacement is usually accompanied by a diagnosis of a deficint Rhomboid, Trapezius, and Latissimus Dorsi development relative to the anterior muscles. These are the muscles most responsible for deceleration of the arm. It is highly common, especially among hard throwers at young ages that these muscles are behind the others in development. Much of that reason is from overlooking their importance in the process by the athlete.

Severe shoulder injuries, like labral tears from throwing (as opposed to labral tears from impact and falls with arm extended), are thought to be primarily caused by deficient decelerator muscles.

Core work is a loose term, but generally considered work below the lats to the hips. These are excellent exercises for pitchers, especially those looking for jumps in velocity. I'm not a PT, but wonder what benifit is being derived for the scap, from developing core?

Most "back" work is initialized with bands and then graduated to resistance with weights, although at 14yo, bands may be the better option.

The fact that it's a rotation deficit also leads to thinking that stretching of the muscles may be needed. Although, BIG ALTHOUGH, internal swelling can also be a primary cause of rotational deficit. If that were suspected, the protocol would likely be NSAID's and rest for 7 to 14 days before initiating any shoulder/back rehab work.

If it were my son, I'd be dosing 440 mg. (2 over the counter tabs) Naproxen twice daily, along with 20 minutes icing and resting for 7 days before initiating rehab. My thinking would be that I'd want to eliminate the possibility of swelling in the joint as the initial cause of the rotational deficit. At that point, I'd be all over the rehab and back strengthening to prevent the swelling and rotational deficit from recurring. Just remember that shoulders can be the toughest of the joints to help. There is little blood flow to both heal and relieve swelling, and pain is not the necessarily the major indicator of injury or severity. MRI's are often (upwards of 20%) indicators of false negatives in diagnosis. So, although it feels good, with shoulders, it's usually wisest not to try to rush them back into service based on feel. They take time to heal, you can't rush them...and that can be frustrating.

That being said, I'm not a medical professional...I'm just a Dad who's had a son with shoulder issues and studied to help him work through them (post op).

I would advise PM'ing Bulldog19 if he doesn't jump in here soon. He is formally educated in these matters.
Last edited by CPLZ
eyeonthe ball

No sarcasm intended but do you realize that each kid reacts differently to injuries and surgery and what their doctor/PT guy recommends--

Having people, as CPLZ is doing, recommend medical dosgaes is totally wrong--that is what doctors are for--posters on a website should not be doing that and if they do you as a parent should not be following it as a recommendation
TR - yes, you are absolutely correct, everyone is different. That said, there is value in discussing injuries because while there certainly are individual differences, there are also similarities. I would not take information provided by anyone on any discussion board (unless it was Dr. Andrews Wink) and act on it. That's why its called a discussion board. Knowledge is power.
Although much that goes on in reccomendations happens behind the scenes in PM's, I can say with 100% assurance that...

1. Doctors are not infallible
2. Trainers sometimes mistreat
3. That I have obtained a great amount of terrific advice, direction, encouragement, and education from networking with parents of other players who have had similar injuries, including many here on the HSBBW.

In my sons recovery from shoulder injury, subsequent surgery and rehab, and return to 100% of his former abilities, much of the good guidance I received from lay people was as valuable as the input from professionals...and in a couple of instances, our direction and path decision was not only greatly influenced by those lay people that had gone before us, but directed by them as well.

All information is good. It is up to us to decide the value.
As I noted earlier, knowledge is power. A great example: the PT my son is now seeing provided a thorough and clear explanation of GIRD and his plan to address it. Because I sat in on a Phil Donley presentation about GIRD at one of Ron Wolforth's pitching coach camps a few years back, I was knowledgable about it and my trust and confidence in the PT was quickly established.

Wow, the insurance issue is surely opening a huge can of worms!
Originally posted by CADad:
1. Agree, it is important to find a doctor you trust, while understanding that even with a doctor you trust you have to stay involved.

2. Trainers and PT's. Once again it is important to find a PT that you trust.

4. Insurance can be a real pain when it comes to getting the best care.

1,2,4 ? Big Grin

We're Americans! We'll never give up. We didn't give up when the Germans Bombed Pearl Harbor, did we?


Never mind, he's on a roll.
Last edited by CPLZ

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