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Sports Science

Shoulder Injuries

Shoulder Injuries in Baseball Players

Shoulder Problems Often Start Early for Pitchers

Baseball isn’t usually associated with the serious injuries seen in rougher contact sports like football. However, 57 percent of baseball pitchers suffer some sort of shoulder injury during a playing season, according to the National Institutes of Health.

Overuse is typically to blame. Repetitive strain on the rotator cuff and surrounding stabilizers and tendons is known to cause cumulative damage with serious consequences.

Career-ending shoulder injuries in adult pitchers often start at the youth-sports level.

Why is the shoulder so prone to injury?

Steven E. Flores, M.D., orthopedic surgeon affiliated with the Memorial Hermann IRONMAN Sports Medicine Institute and assistant professor of orthopedic surgery at The University of Texas Medical School at Houston, explains.

“The shoulder is the most complex joint in the body and it relies on multiple structures for its performance and stability. The ball-and-socket mechanism is surrounded by soft-tissue stabilizers – some static, some dynamic. The complexity that gives the shoulder such tremendous range of motion also makes it especially vulnerable to various injuries, including inflammation, strains, tears and even stress fractures in a skeletally immature young person, all of which can worsen over time.”

Problems serious enough to require surgery are more likely to develop in a shoulder already weakened by inflammation and tendonitis. “Pitchers may experience a feeling of heaviness we call ‘dead arm.’ Even a small degree of weakness can cause muscle imbalance and other repercussions. The safest course is to get proper diagnosis and begin therapy to avoid long-term damage,” says Dr. Flores.

Dr. Flores stresses the importance of developing core strength to protect the shoulder. “The dynamics of pitching requires whole body strength, especially the core and the legs. If those areas aren’t strong enough, the shoulder takes the strain.”

Limiting the Activity

Young baseball players seeking opportunities to develop their skills often play in multiple leagues. Although each league may limit the number of pitches, playing in more than one league means the player will exceed pitching limits and put overuse strain on the shoulder.

USA Baseball’s Medical & Safety Advisory Committee recommends young athletes limit pitches to 75 per game, 125 per week, 1,000 per season and 3,000 per year.

“Injuries we see most often in young baseball athletes – growth plate damage, SLAP or labral tears and partial thickness rotator cuff tears – are mostly caused by overuse or repetitive strain," he says.

Shoulder injuries can also be caused by acute trauma, such as hitting the ground too hard when sliding into home plate, falling on an outstretched arm, or raising the arm against forceful resistance.

Signs and Symptoms

Both tendonitis and a torn tendon can cause a similar range of symptoms, from dull to severe aches and pains, local stiffness, tenderness, limited range of motion, or a burning that surrounds the whole joint around the inflamed tendon. Pain may persist when at rest.

Weakness is a common symptom. If it’s hard to raise your arm above your head or to extend your arm directly to the side or in front, you should see a physician. In most cases, the larger the tear or damage to the tendons, the harder it is to move your arm and the injured area.

Tears get bigger over time and don’t heal without intervention. Left untreated, shoulder problems will cause performance to diminish. Growth plate fractures don’t heal at all, but require surgical repair to regain mobility. Other structural issues such as labral and tendon tears typically do not heal, and often require surgical repair if conservative treatment fails.

Prevention and Treatment

  • Adequately warm up and stretch before exercise, practice or play.
  • Give muscles, tendons and ligaments time to cool down after activity.
  • Diversify your workout to strengthen the shoulder blade and rotator cuff muscles as well as core abdominals, lower back and leg muscles.
  • Ice stiff or sore joints after exercise.
  • If you feel pain or weakness, stop the activity and seek medical attention.
  • Injury may require up to three months rest, rehab, play simulation and gradual return to play.
  • Arthroscopic surgery may be required to repair tears, lesions or growth plate fractures.