Elbow and Shoulder Injuries

BY JAMES S. BURKHARDT, D.O.
 

This baseball season promises to be very exciting and for Red’s fans expectations are high. Injuries are certainly a part of sports. Every manager, coach and player is well aware of how injuries can derail a season for a team and a career for a player.

This month’s article will review 2 common injuries often associated with baseball players: elbow and shoulder injuries. These commonly involve tendons and ligaments around those joints. Ligaments connect bone to bone and tendons connect muscle to bone.

Anyone can sustain a ligament injury to the elbow from repetitive activities or from trauma. But athletes that throw have the highest risk. That’s because the overhand throwing motion puts extreme stress on the joints. In the elbow, the ligament which is at most risk is the ulnar collateral ligament. This ligament connects the upper arm bone, the humerus, to a bone in the forearm. It is located on the inside of the elbow.

Over time and with the excessive activity such as throwing in general, and pitching in particular, the ligament can develop small tears and begin to fray. The ligament stretches and lengthens until it does not hold the bones tightly enough during throwing activities.

Tommy John surgery repairs a damaged elbow ligament. It is most commonly performed on college and pro athletes, especially baseball pitchers. The surgery is named after former Los Angeles Dodgers pitcher Tommy John. In 1974, he underwent the first surgery of this type. During Tommy John surgery, the surgeon replaces the ligament with a tendon that is taken from someplace in the patient’s body, usually from the forearm or hamstring.

When Dr. Frank Jobe performed this operation, he thought the pitcher only had a 1 in 100 chance of resuming his professional baseball career. But Tommy John returned to pitch for 14 more years in the major leagues and win 164 more games.

Now this procedure is commonly performed. In fact, often pitchers return throwing harder than they did prior to the surgery. This phenomenon of increased velocity has prompted some to consider undergoing surgery to “get it over with” to start recovery and have greater velocity on the fastball even without a ligament tear.

A rotator cuff injury is a strain or a tear of a tendon in the shoulder. The rotator cuff is a group of four muscles and tendons that hold the arm onto the body and allow movement in the shoulder. They run from the shoulder blade out to the top part of the arm. There are 4 muscles that make up the rotator cuff. They are the supraspinatus, infraspinatus, teres minor and subscapularis. These tendons connect the muscles to the arm bone, the humerus.

Sometime these tendons can become damaged, especially with overhead movements. Certain sports such as baseball (mainly pitchers), swimming, tennis, football and volleyball place heavy use on these tendons and can gradually strain the tendon. Visualize rubbing a rope over a rock and understanding how that rope can fray and weaken. That is how the muscle and tendon unit in the shoulder can get damaged.

ymptoms of rotator cuff problems include shoulder pain and muscular weakness. Range of motion is usually limited especially overhead motion and internal rotation. You can reproduce external rotation by the movement you use to put on a coat by sliding your arm in your sleeve.

tendon in your shoulder can be inflamed, partially torn, or completely torn. What is done about it depends on how much damage has occurred and how much it hurts.

f your tear is a minor one, it can be left to heal by itself if it does not interfere with your everyday activities.

f you have a bad tear, you may need to have it repaired by arthroscopy. Arthroscopy can be used to perform surgery on a joint as well as to see inside the joint. The rough edges of a torn tendon can be trimmed and left to heal. Larger tears can stitched back together. After surgery, your treatment plan will include physical therapy to strengthen your shoulder as it heals.

s always for more information about elbow or shoulder injuries, your family doctor should be your first source for help.