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long story semi short: threw ball from outfield wall to 2b. Thought he felt pop in shoulder. Two days later was catching big time loss of arm strength. Went to specialist 3 days later xrays negative ortho said structurally solid after tests. 3weeks rest and moxicam went out to throw today due to follow up appointment tomorrow. No pain when throwing football but pain when throwing baseball hard. Anyone have ideas? I'm assuming mri will be scheduled tomorrow just wondering if anyone familiar with symptoms 

Original Post

My son went through a period of shoulder pain several years ago.  I'll share some thoughts to help give you perspective, and maybe some follow-up questions to ask your ortho.

My son had a very similar experience to your son.  He was playing in a USA tournament and played something like 8 games in 6 days in 110+ heat in AZ.  In the last game he felt a sharp pain in his shoulder.  We took him immediately to an ortho who gave him a battery of tests and x-ray and declared his shoulder structurally ok.  The recommendation was that it was overuse in extreme heat and he should rest.  This didn't sit well with me so we found another ortho... basically the same diagnosis, but with a recommendation to go to physical therapy.  It turned out my son's shoulder was extremely tight with very limited range of motion.  He went to PT and got stretched out and improved his range of motion.  He could rest for a couple weeks and be ok, but then it would flare up again.  This went on for many months, perhaps a year.  Each time I feared the worst and worried about a labrum tear, and deep down I wondered if the orthos were missing something really bad.

The pain, it turned out, was bicep tendonitis from friction in the shoulder when it wasn't extremely flexible.  We found a new PT who figured out how to stretch his shoulder so the capsule inside could be properly stretched.  Once he figured this out his shoulder never had a problem again.  This guy was more helpful and seemed to know more about shoulders than the orthos.

Smitty thanks for responding. Very interesting. First, my son caught 5 games in 48 hours in heat indexes over 108 72 hours prior to the injury    im very intrigued by what youre saying about the tight shoulder because I know his is tight I can tell when he throws. Should I ask ortho about that tomorrow? Do I just need to find someone that can stretch the shoulder capsule? The similarities between our 2 boys injuries are interesting. Football starts next week so we have to move fast lol 

 

I realize players are young and resilient. I went through travel ball with my kids playing three, four games in a day. I would shake my head because pro players aren’t put through this much ball in a day or weekend.

There wasn’t travel ball when I was growing up. Legion was the elite level of ball. We never played more than two in a day.,

@edcoach posted:

Smitty thanks for responding. Very interesting. First, my son caught 5 games in 48 hours in heat indexes over 108 72 hours prior to the injury    im very intrigued by what youre saying about the tight shoulder because I know his is tight I can tell when he throws. Should I ask ortho about that tomorrow? Do I just need to find someone that can stretch the shoulder capsule? The similarities between our 2 boys injuries are interesting. Football starts next week so we have to move fast lol 

 

Definitely ask the ortho about his range of motion, general flexibility, and if tightness can be a root cause of this pain.  I would also ask about physical therapy - if the ortho provides a prescription for it your health insurance may pick up the tab (at least it did for us).  

I wish I could tell you how to find a good physical therapist... my son had a couple that didn't seem to be worth the hour on the bench, and the third one we found worked magic.  I guess I would say if he doesn't feel a dramatic improvement from his therapist, go find another until you see results.

My son also played football, and he loves hitting the weight room, and I'm sure this contributed to his tightness.

@edcoach posted:

long story semi short: threw ball from outfield wall to 2b. Thought he felt pop in shoulder. Two days later was catching big time loss of arm strength. Went to specialist 3 days later xrays negative ortho said structurally solid after tests. 3weeks rest and moxicam went out to throw today due to follow up appointment tomorrow. No pain when throwing football but pain when throwing baseball hard. Anyone have ideas? I'm assuming mri will be scheduled tomorrow just wondering if anyone familiar with symptoms 

Did he just go out and throw without a rehab program?  

@edcoach posted:

smitty by the way the dr told him he could still lift but no maxing out and nothing overhead. Did you get same response?

My son still lifted (and lifts) but he was never big on overhead lifts.  He does a lot of squats and deadlifts, some bench press along with complementary back/lat lifts.  The key for him was to continue stretching, hitting and throwing while he was doing off season lifts so he could adapt to his growing body.

I’d recommend making sure whoever you take him to specializes in baseball or at least overhead sports. A friends kid had a similar issue. The PT the ortho sent him to had some stretches that my friend ran by the baseball trainer that were not good for baseball and could cause further injury. One he mentioned is the sleeper stretch. Apparently this is causing a lot of serious injuries right now. 

Just got back from the ortho. He did a flexibility test and recognized how tight the shoulder was. Before this test he was thinking mri. I asked him if he had a good pitcher/shoulder physical therapist and he gave me a referral. Thanks to those for the suggestion on the tightness.  Makes perfect sense. Since the last summer or two hes looked really tight throwing in the shoulder area. Starts pt Wednesday ill update progress. Thx again. Ed

@edcoach posted:

Just got back from the ortho. He did a flexibility test and recognized how tight the shoulder was. Before this test he was thinking mri. I asked him if he had a good pitcher/shoulder physical therapist and he gave me a referral. Thanks to those for the suggestion on the tightness.  Makes perfect sense. Since the last summer or two hes looked really tight throwing in the shoulder area. Starts pt Wednesday ill update progress. Thx again. Ed

This sounds like good news.  Good luck with the PT.

Went to the physical therapist today. Pt said his range of motion and shoulder flexibility was awful. Did a few tests and by the end of the hour the flexibility really improved    the pt thinks this is the problem almost for certain but said if not a mri will be necessary  he was approved for 60 pt sessions by insurance but i have $50 copay so won't be using them all

No on the approval for mri right now. I may wait from what I'm t old its almost the same to pay cash for the mri and would get done fast. If he has any pain at all throwing coming up ill get it going immediately  the tightness thing just makes sense hes looked very stiff  throwing the last two years. I couldn't believe the improvement after 1 session. Going again Friday can't wait to see how that goes

How long will it take to find out if you need the MRI? Are you approved for the MRI now? If so you may want to just get it out if the way instead of waiting a few weeks and finding out there are other issues. 

Glad to hear things seem to be getting better though. It’s amazing what those guys can do for aches and pains. 

I was literally going to write the same exact thing. If insurance approves the MRI do the MRI now but don't wait to start PT.  Where I live it takes a few days to get an MRI appointment, then a few days for the readout.   Before your son heads off to college maybe get this MRI done.  I would.

I will add that 60 PT sessions are way too many (well I think that is a ton).  I must be a misunderstanding.  My son just finished his 12th or 13th and has maybe 2 more to go but perhaps range of motion issues are different and require more work.

GM he leaves Saturday but he's less than 30 minutes away so it won't be a problem to get it taken care plus I'm thinking maybe his university would have access to an mri machine (through the athletic trainer). I have blue cross blue shield its an amazing policy. I dont think he needs 60 but she told him he's approved for 60

Last edited by edcoach

Best of luck to you and your son,

Find limitations in strength, address any fears/concerns with reassurance, gradually build back into throwing when appropriate (don't just go 0-100). So if throwing at 50% is okay, great, that's a starting point to build off from. Maybe throwing 50% but can only go about 100 feet before pain, then back off a bit, build up the volume over time. If the next day pain increased, then either did too much (maybe throw 8 sets of 5 with 3-5 min breaks in between instead of 4 sets of 10), or maybe a set or two was at 70% intensity, or maybe didn't get much sleep the night before, or is really stressed out (worried about injury or other life events), this can increase pain sensitivity

Some of the biggest keys for injury can be a huge spike in volume (so.. catching 5 games in 48 hours plus [what sounds like] a maximal intent throw from the outfield wall to 2nd base), chronic lack of sleep, already sore arm, and stress. Add any and/or all of that together and you may get an injury.

I'm not sure of your son's level but findings on MRI are common (for instance, there was a study in 2018 looking at little leaguers and found 4/23 had a torn labrum but no pain and fully functional), so if they don't think it's necessary I wouldn't really push for it.. because once you have it done you can't unsee it.

Hell last year there was a study done on the US indoor volleyball team, completely asymptomatic (again, meaning no pain or anything like that) and found 23 of the 26 athletes had rotator cuff tendinosis, 17 had rotator cuff tears, and 12 with labral tears. 

So ideally they tested strength with a dynamometer, talked about the best plan of action to get back to it, all that good stuff.

Not huge into stretching, personally (that is my bias), I feel there's absolutely more bang for your buck ways to restore motion if there's a loss (i.e. through strength training, and you get the added benefit of building tissue capacity and strength and power and confidence).

But however it's handled, hope all goes well, recovers and is able to kick butt again

Don't mess around with Shoulders. The anatomy of the human shoulder is complex. Push Ortho for an MRI ( w/ dye) . If there is structural damage, Labrum, Rotor Cuff. You need to know NOW. Not in 3-6 months.

The reason being , assuming he's a serious player w/aspirations to play at the next level, If there is structural damage, and surgery is necessary , you want to do that immediately because post op recovery is a lengthy process for baseball players and will have an impact recruiting timelines.

My son was a 2016 LHP . He was an early commit to a D1in the south. He experienced similar 'pop' then subsequent soreness in fall of JR year in HS. We did PT and no throw programs to no avail. Got the MRI. Imaging confirmed torn labrum. Otho recommended surgey. Son opted for alternative treatments. PRP, etc..............None of it worked. We spent a solid year on non surgical treatments without any tangible results.

Son ended up getting surgery Freshman year in College. The subsequent rehab process was 18 months.

If we had a do over, it would have been immediate MRI followed by necessary surgery. No one wants to deal with the timelines surgery involves. But the bitter truth is that most Shoulder injuries don't heal themselves if there is in fact, structural damage.

Baseball players can't play baseball if they can't throw. Knowing what I know now, once you get an MRI with structural damage, you surgically fix it immediately. Just like pro ball does it.

I'm hoping your son is just experiencing some sort of tendonitis related thing. But don't take any chances, push the Ortho for MRI as soon as possible.

 

=Good luck!

 

 

*Anything I type here is just based on my personal experience as the parent of an amature baseball player

 

Last edited by StrainedOblique
Son opted for alternative treatments. PRP, etc..............None of it worked. We spent a solid year on non surgical treatments without any tangible results.

If we had a do over, it would have been immediate MRI followed by necessary surgery. No one wants to deal with the timelines surgery involves. But the bitter truth is that most Shoulder injuries don't heal themselves if there is in fact, structural damage.

Baseball players can't play baseball if they can't throw. Knowing what I know now, once you get an MRI with structural damage, you surgically fix it immediately. Just like pro ball does it.

I'm hoping your son is just experiencing some sort of tendonitis related thing. But don't take any chances, push the Ortho for MRI as soon as possible.

 

=Good luck!

 

 

*Anything I type here is just based on my personal experience as the parent of an amature baseball player

 

I'm so sorry that none of the medical professionals he saw at the time did not inform either you or your son that PRP is not indicated for much of anything in orthopedics, and especially not the shoulder. Lot of wasted time there, I'm sorry he had to go through that.

From having no effect on supraspinatus tears (but having worse adverse effects compared to saline) https://journals.sagepub.com/d...097?journalCode=ajsb to having no effect on patellar tendinopathy https://pubmed.ncbi.nlm.nih.gov/31038979/ same with lateral epicondylitis https://pubmed.ncbi.nlm.nih.gov/32103373/ and to top it all off, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6214820/ which states: The results of this meta-analysis, which documents the very marginal effectiveness of PRP compared to controls, does not support the use of PRP as conservative treatment in orthopaedics.

As for the bitter truth that shoulder injuries don't heal themselves, well, they do - and surgery isn't always necessary, and some don't even out perform sham surgery where nothing is done (looking at labral repair for type 2 SLAP lesions, rotator cuff tears, and shoulder "impingement"). There are also a lot of people, including baseball players, that have "structural damage" and are fully functional and pain free.

This is why it's important to understand the patient, their expectations, and their relevant clinical findings and medical history. Not everyone needs imaging, but again that's based on symptoms/history/clinical findings.

Can surgery be an effective treatment? Absolutely 100%. Can PT be effective? Absolutely it can be. It's more nuanced than always needing imaging.

It's well known that there are abnormal findings on MRI in asymptomatic baseball players https://pubmed.ncbi.nlm.nih.gov/11798999/

Little Leaguers https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5826014/ whose discussion talks about: Asymptomatic rotator cuff tears and labral tears have been shown to be present in 21%-52% and 40%-48% of Major League Baseball pitchers

Draft picks https://pubmed.ncbi.nlm.nih.gov/26529676/

Adults https://onlinelibrary.wiley.co...1111/1756-185X.12476 whose conclusion states: Shoulder pathology is apparent in both symptomatic and asymptomatic shoulders and clinical symptoms may not match radiological findings. The cost burden of ordering MRI scans is significant and the relevance of the findings are questionable when investigating shoulder pain.

More adults https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4710128/ whose conclusion states: Superior labral tears are diagnosed with high frequency using MRI in 45- to 60-year-old individuals with asymptomatic shoulders. These shoulder MRI findings in middle-aged populations emphasize the need for supporting clinical judgment when making treatment decisions for this patient population.

So ultimately, it's way more nuanced than you should always get imaging, or that it's needed. I'm not saying this person does or doesn't because I have no idea who they are. But if you MRI a professional pitcher who does not have shoulder pain and is fully functional, chances are you will find a rotator cuff tear, maybe a labral tear, etc... which, I'll take it back to my original point, it depends on the person in front of you, goals/expectations/beliefs, and relevant clinical findings.

But again these are my thoughts, any and everyone on here is well within their rights to say "Poo poo to that, I'm getting imaging no matter what," and that's absolutely your right to ask for that, and then it's the clinician's role to either explain it's not necessary, or if it is, say absolutely we're going to be getting imaging done.

@XFactor posted:

I'm so sorry that none of the medical professionals he saw at the time did not inform either you or your son that PRP is not indicated for much of anything in orthopedics, and especially not the shoulder. Lot of wasted time there, I'm sorry he had to go through that.

From having no effect on supraspinatus tears (but having worse adverse effects compared to saline) https://journals.sagepub.com/d...097?journalCode=ajsb to having no effect on patellar tendinopathy https://pubmed.ncbi.nlm.nih.gov/31038979/ same with lateral epicondylitis https://pubmed.ncbi.nlm.nih.gov/32103373/ and to top it all off, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6214820/ which states: The results of this meta-analysis, which documents the very marginal effectiveness of PRP compared to controls, does not support the use of PRP as conservative treatment in orthopaedics.

As for the bitter truth that shoulder injuries don't heal themselves, well, they do - and surgery isn't always necessary, and some don't even out perform sham surgery where nothing is done (looking at labral repair for type 2 SLAP lesions, rotator cuff tears, and shoulder "impingement"). There are also a lot of people, including baseball players, that have "structural damage" and are fully functional and pain free.

This is why it's important to understand the patient, their expectations, and their relevant clinical findings and medical history. Not everyone needs imaging, but again that's based on symptoms/history/clinical findings.

Can surgery be an effective treatment? Absolutely 100%. Can PT be effective? Absolutely it can be. It's more nuanced than always needing imaging.

It's well known that there are abnormal findings on MRI in asymptomatic baseball players https://pubmed.ncbi.nlm.nih.gov/11798999/

Little Leaguers https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5826014/ whose discussion talks about: Asymptomatic rotator cuff tears and labral tears have been shown to be present in 21%-52% and 40%-48% of Major League Baseball pitchers

Draft picks https://pubmed.ncbi.nlm.nih.gov/26529676/

Adults https://onlinelibrary.wiley.co...1111/1756-185X.12476 whose conclusion states: Shoulder pathology is apparent in both symptomatic and asymptomatic shoulders and clinical symptoms may not match radiological findings. The cost burden of ordering MRI scans is significant and the relevance of the findings are questionable when investigating shoulder pain.

More adults https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4710128/ whose conclusion states: Superior labral tears are diagnosed with high frequency using MRI in 45- to 60-year-old individuals with asymptomatic shoulders. These shoulder MRI findings in middle-aged populations emphasize the need for supporting clinical judgment when making treatment decisions for this patient population.

So ultimately, it's way more nuanced than you should always get imaging, or that it's needed. I'm not saying this person does or doesn't because I have no idea who they are. But if you MRI a professional pitcher who does not have shoulder pain and is fully functional, chances are you will find a rotator cuff tear, maybe a labral tear, etc... which, I'll take it back to my original point, it depends on the person in front of you, goals/expectations/beliefs, and relevant clinical findings.

But again these are my thoughts, any and everyone on here is well within their rights to say "Poo poo to that, I'm getting imaging no matter what," and that's absolutely your right to ask for that, and then it's the clinician's role to either explain it's not necessary, or if it is, say absolutely we're going to be getting imaging done.

I agree with many of your points and my sons ortho also mentioned most people 40+ who played any kind of overhead type sport has some sort of shoulder issue, including torn labrums. 

Having said that I would absolutely get an MRI to at least have a base/starting point and to confirm a diagnosis and PT program.  My son was diagnosed with a torn labrum which we decided to rehab to get him through the summer showcase circuit and if all went well he could avoid surgery.  After 3-4 months of PT he was able to get back to playing at a high level.  However, by the start of his Sr. year in HS the pain had returned and he was not able to continue playing.  He ended up having surgery and 4 anchors put in.  It was a long recovery process and his shoulder is still not 100% and probably never will be.  The good news is he was healthy enough to come in and be the only freshman starter on his college team.  I should also mention this was his non throwing shoulder.

Thank you all for all of your responses. Hes currently at the university and football is starting.  Hes been doing the pt and things are going great with the pt. The second he tells me he has any pain we will get the mri.  He hasnt thrown anything other than a 5 minute session with me and won't throw a baseball for a while. I pray this covid doesn't take their seasons but it would give a chance to heal if he has to do something more aggressive 

 

I'm going to add something that I'm sure will get push back. It's situational, but I caution about getting an MRI too quickly. My son had back problems that sidelined him from the mound for the first half of his senior season. Doctor sent him for an MRI. They found three bulging discs, but concluded none of them were in a place that would have caused the pain he was feeling. After closely comparing video from before the pain and after, I discovered a mechanical change in his delivery. Fixing that completely relieved him of the pain - never been a problem since. Great, huh? 

Well move ahead a year and he's become a draft prospect. Several clubs interested and talking somewhere between the 11th and 20th rounds. However, ALL of them wanted a copy of that MRI. Boom. Suddenly, if they wanted him at all, it was lower rounds for much smaller bonus offers. 

Almost all ball players, if you get an MRI, are going to show damage to shoulders - it's just what comes with the territory. I'm not saying don't get an MRI. I'm just saying I think sometimes people jump immediately to an MRI too early when it may not be the best idea or necessary.

@roothog66 posted:

I'm going to add something that I'm sure will get push back. It's situational, but I caution about getting an MRI too quickly. My son had back problems that sidelined him from the mound for the first half of his senior season. Doctor sent him for an MRI. They found three bulging discs, but concluded none of them were in a place that would have caused the pain he was feeling. After closely comparing video from before the pain and after, I discovered a mechanical change in his delivery. Fixing that completely relieved him of the pain - never been a problem since. Great, huh? 

Well move ahead a year and he's become a draft prospect. Several clubs interested and talking somewhere between the 11th and 20th rounds. However, ALL of them wanted a copy of that MRI. Boom. Suddenly, if they wanted him at all, it was lower rounds for much smaller bonus offers. 

Almost all ball players, if you get an MRI, are going to show damage to shoulders - it's just what comes with the territory. I'm not saying don't get an MRI. I'm just saying I think sometimes people jump immediately to an MRI too early when it may not be the best idea or necessary.

Somehow, the "edit" button won't update. That should have read *junior* season.

@edcoach posted:

Hey Guys, just an update....has been throwing with some pain and I told him if he feels any pain wed do the MRI....MRI scheduled for tomorrow (Tue 9-1) and follow up 9-8...appreciate any prayers you all could provide...hoping for the best for sure...take care  Ed

I shared with you in a PM but feel ok to share now.  My son (Freshman college now) had shoulder pain at the end of June.  We went to doc who did Xray and tests and predictably sent us for an MRI.  The MRI was not at their facility and was read out by a different doctor who saw nothing structural.  We had our follow up with our doc and he saw a labrum tear (small) but one he insisted needed surgery.  Told us PT would not work (crazy comment).   We got a second opinion and that Doc showed us massive inflammation and she told us if you took an MRI of every 18 year old pitcher you would see small labrum tears on half who would be showing no symptoms, and she couldn't really confirm a small tear from the MRI.  Son did 21 sessions of PT between early July and his start of college on 8/20.   PT made a huge difference and he is throwing without any pain currently.  

I wondered if the first Doc, who didn't have any elective surgery for many months, was quick with the surgery suggestion for financial reasons.  I know that sounds horrible but his advice seemed strange and his rush to perform surgery set off alarms.  So I say get that MRI and if they say there is a big issue and your son needs surgery make sure you get a second opinion.   Second opinions are really key for all major decisions, IMO.

Take it from me the last thing you want to do is perform surgery on the shoulder.  Tequilla gives good reason in his post today.  I have had Labrum tear surgery.  I am not the same.  Thankfully I can serve in paddle or tennis, its all I got.  I can't throw a baseball.  Many come out of these surgeries fine but my personal opinion is make surgery a last resort, always get a second opinion.  Good luck to your son, i would be hopeful that more PT will solve his issue.  

thanks GMJ...definitely will seek the 2nd opinion if necessary.  Im hoping they tell us its tendonitis or something not as serious as a labrum tear.  Hes been going to pT for 3 weeks or so and the flexibility and strength is improving per the pt but I guess still feels pain when throwing...heck it could be soreness from the pt showing up when he's throwing, or maybe im wishful thinking..we will find out soon

@edcoach posted:

thanks GMJ...definitely will seek the 2nd opinion if necessary.  Im hoping they tell us its tendonitis or something not as serious as a labrum tear.  Hes been going to pT for 3 weeks or so and the flexibility and strength is improving per the pt but I guess still feels pain when throwing...heck it could be soreness from the pt showing up when he's throwing, or maybe im wishful thinking..we will find out soon

Based on the way you said it came on it probably is just inflammation and its still there.   It really took my son 6-7 solid weeks of consistent PT.   He had some pain 4 weeks ago still.   Last 2-3 weeks no pain but I am holding my breath still so I know exactly how you feel right now.  Team practices start 2 weeks from today.

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