The pitching sequence generates extreme forces through the body. A major league pitcher uses his legs, hips, trunk, shoulder, elbow and wrist to generate 1,000 pounds of force to the baseball. The shoulder is a key part of the sequence, not only to help generate that force but also to safely slow the arm down once the basball is released. Repetitive pitching can cause overuse injuries to both the bony structures and soft tissues. Symptoms include pain at the shoulder and loss of velocity and accuracy with pitching.
Little Leaguer's Shoulder
The growth plate, or epiphysis, is an area of growing tissue in the ends of long bones in growing children and adolescents. It is also weaker than bone and the site of injury in little leaguer's shoulder. With this condition, you get pain at the epiphysis of the shoulder, and you can even get widening of that epiphysis seen on an X-ray. You can prevent this by adhering to pitch count limitations set by baseball governing bodies and using good pitching technique. Treatment includes rest from throwing and physical therapy.
Rotator Cuff Injuries
The rotator cuff is a group of four muscles that serve to stabilize the shoulder. They originate on the shoulder blade and insert at the head of the humerus. Injury to the rotator cuff is really a spectrum of disorders, with tendinitis on one end of the septrum to a complete tear of the cuff on the other. You can also have partial tears. Treatment includes rest, physical therapy, corticosteroid injections and surgery.
Labral Injuries
The labrum is a rim of cartilage on the glenoid (the socket part of the shoulder joint). The labrum serves to deepen that socket and provide a site for attachment of ligaments and the biceps tendon. With repetitive throwing, the labrum can tear or even peel back off the glenoid. If a tear of the labrum exists, physical therapy is first line treatment, but surgery is usually required to return to a high level of pitching.
References
- DeLee and Drez's Orthorpaedic Sports Medicine, 3rd Edition; Jesse C Delee, MD, David Drez, Jr, MD, and Mark D. Miller, MD; 2009
- "Current Sports Medicine Reports"; Baseball and Softball Injuries; Quincy Wang, MD; June 2006
