Pitching after shoulder labral tear

[gator5]

My daughter injured her throwing shoulder at the end of January. She has been in PT since and we are hoping to get an MRA soon. The doctor is unsure if she has impingement or if there is a labral tear. [won't bore you with all the details. We are getting a second opinion] So I a writing just as a fact gathering endeavor and hoping she does not have a tear.

Most of the studies I have read on labrum tears do not paint a good picture for baseball pitchers I have done a few searches on here for labrum tears, but most of the posts are like mine are right after the event happens. I am hoping for a big picture response.

If your daughter, or someone you know, has had a shoulder labral tear, can you please answer the following:

What kind of tear was it? I am guessing a SLAP 2 but any information would be great like the severity of the tear.

Did she have surgery or opt just for PT?

Did she ever return to pitching? If so, was it at the same level as before?

 

[Vertigo]

So not softball but baseball - my son was diagnosed with a SLAP tear via MRA back in the fall. Never really had a lot of pain, but felt his shoulder “not feel right” while just throwing in the OF. His primary position is pitcher.

His tear is 10 to 2, so superior. After doing a ton of research and discussing it with our orthopod, we opted for PT first to see what would happen. He did about 12 weeks and then progressive throwing. Doc told us that if he pitches and he doesn’t get his velocity back, then he might need to just play the field.

He eased his way back into pitching - pitching coach was extremely conservative with him. PT helped to strengthen the RTC muscles and now he is back to full velocity off the mound. It took about 5 months of rest, PT, then slow progression to throwing but so far, so good. No pain and velocity is back. Doc thinks he may have already had the tear and then something else happened to cause the pain. If you research SLAP tears, many times this is the case.

If you don’t mind me asking, where is her pain? I wish you all the best and hopefully no surgery will be needed. Just make sure you do a lot of research, find a good orthopod that specializes in shoulders/sports injuries, and find a great PT!!!

 

[Vertigo]

Also wanted to add - my husband was always very good and cautious about him pitching. Always followed pitch counts and never over threw him (he was his coach up to about a year ago). He also made sure that his current TB coach never overused him, either. So it seems like it was just a freak thing for him.

He now does regular strength training and band work at home to keep the RTC muscles strong. We have done preventative PT with dd who also is a pitcher to help protect her arm, as well.

ETA: My son is 15 years old and has been growing like a weed. Not sure if that factored in.

 

[Vertigo]

My other recommendation would be to definitely try and push for the MRA ASAP. We started PT not knowing exactly what the issue was and the therapy he was doing was causing more discomfort.

 

[gator5]

If you don’t mind me asking, where is her pain? I wish you all the best and hopefully no surgery will be needed. Just make sure you do a lot of research, find a good orthopod that specializes in shoulders/sports injuries, and find a great PT!!!

Thank you for your answers!

Initially, she woke up after practice and could not brush her hair or put her hand behind her back. OS said her biceps were definitely inflamed and ordered PT. After 3 weeks of PT, the biceps were no longer in pain, and she had functionality back in her shoulder. But, starting at week 3 of PT, we are in week 5 now, she started getting popping sounds from her shoulders on certain movements. No pain, but popping (sometimes my daughter says grinding. But I have learned over the years she is terrible at describing things) . The doctor, and PT person, can both hear and feel this. The doctor is not that concerned. The PT person is (as I am ). From what I have read on-line, my daughters symptoms are right in the middle of shoulder impingement vs labral tear. OS wants to wait 3 more weeks before considering MRA.

My daughter passes all the strength tests for the shoulder, but as you stated for your son, it just does not feel right to her when she hears the pop. She "knows" if she were to try to pitch, it would pop every time.

Tomorrow we are going to OS for the Washington Nationals. Well, we will see the PA who will hopefully order an MRA.

My daughter is a junior in HS. Of course with NLI day in 8 or so months, that looms on our minds. It won't make us do anything stupid, but it certainly adds to the uncertainty of the situation.

 

[Vertigo]

My dd did have a posterior shoulder impingement a while ago and she had very sharp pain when she cocked her arm back to throw overhand, but never had any discomfort with it pitching. Weeks of PT and rest fixed that up pretty quickly.

My dd has always had some popping in her shoulder and while undergoing PT she felt it a lot as the impingement was resolving. She never had pain with the popping and had resumed pitching without any issues. Now, she does have very loose joints genetically, so almost everything “pops” on her - knees, ankles, elbows, hips. I agree you should be concerned as this is something new for your dd. Hopefully the MRA will provide some answers - fingers crossed for good answers!

 

[BStine]

The popping could be her shoulder blade hitting her ribs. I had to go through therapy on my left shoulder for this years ago, caused by poor posture and exacerbated by an injury. If you feel her back at her shoulder blades, if the feel "winged" (not flat or even with the rest of the back) then that may be part of the problem.

My own pitcher had a similar issue, caused by an injury and it ended up with poor posture and winged shoulder blades. She could throw overhand and bat but not pitch. She didn't have surgery and is back to pitching after therapy. Her control never returned 100% and it takes her longer to stretch and warm up.

 

[gator5]

Just got our MRI results today. It is not a labral tear. So my attempt to find things out was off-base. Results state: minimal tendinosis of the distal supraspinatus tendon. Tendinosis is worse than tendinitis but better than a tear or rupture. We see the doctor on Monday to figure out the plan.

 

[danyabueno77]

Just got our MRI results today. It is not a labral tear. So my attempt to find things out was off-base. Results state: minimal tendinosis of the distal supraspinatus tendon. Tendinosis is worse than tendinitis but better than a tear or rupture. We see the doctor on Monday to figure out the plan.

How is your daughter

 

[gator5]

How is your daughter

What a LONG ordeal this has been.

Summary: Now 1.5 years later, only in the last month has she started to look like her old self.

Now for the details

So she did 4 or so months of PT. They spent less time on the actual shoulder injury, and more time on the whole shoulder. I could not have been any happier with the PT work.

So May rolls around and she starts pitching some with me. PT said 50 pitches a day is the limit. We only threw 3 times a week. We basically worked only on fast and change. Not ideal, but we were trying to rebuild the throwing arm, and none of us wanted any strain from spin pitches. She came out in June throwing as hard as I have ever clocked her (granted I did not clock her in the fall) 59-61 mph in games. She looked great speed wise although her pitching arsenal was smaller. The coach went heavy on screwball calls, which we had not been practicing, And within one tournament, she had aggravated her triceps. That caused issues with the coach knowing what pitches to call - it was a whole ordeal that should not have been an ordeal.

Anyhow, roll around to early August. PT removes restriction. The first tournament, coach pitches her 70 pitches on day 1. She was over 200 pitches in day 2 and suffered an MCL sprain (level 1) on the 207th pitch. She went from 0 to full blast too quickly and had not built up those muscles. We rested the next few weeks before the fall season, but it was still an issue on Labor Day. So she was out 6 more weeks doing PT on that.

All seemed to be going well this spring when she tweaked her knee in April on a hike. Then she tweaked her biceps in June in her first live game since the fall. (we figured out from overhand throwing so she cut that out) So we were back on a limited pitch count all summer. Finally in early July, she was able to pitch 2 games in a day (about 170 pitches and she told the coach that was all. We learned from the previous fall) And then the next weekend, her speed finally came back.

I clocked her at 61 this past weekend. She looked like she did in the fall 2 years ago. She took off her knee brace mid-inning in her last game. First time in a year without a brace.

She still does shoulder and knee pt exercises to keep things strong.

Of course I am a little wary since she has only been all the way healthy for a month now. But I trust her college trainers will be up for the task if she has any issue.