The Rotator Cuff

by paspapt

Spring is in the air!  Flowers are blooming.  The weather is getting warmer.  Allergy medicine is flying off the shelves.  It also means that baseball season is in full swing around the corner.  It’s that special time of year where fans of every team (yes, even the Cubs!) can dream of being World Series champions.  However, injuries can turn every fan’s dream season into a nightmare in an instant.  Baseball players (especially pitchers) are very susceptible to shoulder injuries, and rotator cuff injuries are among the most common.

The rotator cuff is a group of four muscles and their tendons that help to stabilize the shoulder joint.  Those muscles are the supraspinatus, infraspinatus, teres minor, and subscapularis.  They act together to keep the head of the humerus in the shallow shoulder joint.    When raising your arm, the rotator cuff muscles compress the glenohumeral, or shoulder,  joint to allow your larger shoulder muscles (primarily the deltoid) to further raise the arm.  These muscles also serve as internal and external rotators for the arm, two very important motions for throwing a ball.  These muscles must be strong enough to work against very high velocities of rotation in the arm (up to 7000 degrees/second!).

The rotator cuff muscles as they are seen in the shoulder

For pitchers, having these muscles working optimally is paramount to avoiding injury.  If these muscles are not working as they should, the head of the humerus will ride upward and compress the space above the joint.  This can lead to irritation of the tendons and, if left untreated, a rotator cuff tear.  Muscular imbalances, improper throwing biomechanics, or overuse are all causes of rotator cuff problems.

Initially, conservative treatments such as oral anti-inflammatories, physical therapy, and abstaining from throwing for some time are done to see if the injured tendons will heal.  Sometimes, doctors will do a corticosteroid injection to bring down the inflammation.  Once a patient is pain free, he can begin Thrower’s Ten exercises, a series of exercises designed to increase shoulder and scapular musculature strength.  When the player has regained his shoulder and scapular strength, he can begin a modified throwing program.  

An example of a few of the “Thrower’s Ten” exercises

If conservative treatment does not help the player return to playing, surgery can be performed to repair the torn tendon.  This is usually done arthroscopically; for massive tears, the doctor will perform open shoulder surgery (though doctors will try to avoid this as much as possible).  Rehabilitation after surgery is a long process, as patients cannot begin sports specific activities until about five months post-operatively and cannot throw until about six months.  

So if your fantasy team’s number one pitcher should unfortunately have a rotator cuff injury at some point during the season, does this mean he is done for the year and it’s time for you to hit the waiver wires?  Not necessarily.  Keep a watchful eye to see the severity of the injury.  If a tear is suspected, he may have surgery and the player may be shut down for the year.  With tendonitis or irritation of the tendon, the player might just be on the disabled list briefly and should return.  Many players, such as the Pedro Martinez and Orlando Hernandez, have recovered from rotator cuff injuries.  

“El Duque” Orlando Hernandez, a rotator cuff injury success story!

However, the success rate for recovering from rotator cuff surgery are mixed, and there are many players that never return to their pre-surgery status.  A recent study in the Journal of Athletic Training showed that pitchers that had rotator cuff surgery had three seasons of gradual improvement, but they never fully returned to their pre-injury form.  Each pitcher has many different variables (age, injury history, extent of injury, pitching biomechanics, and others) that play a role in whether or not they will fully recover from a rotator cuff injury

So kick back, relax, and get ready to “play ball!”  Just hope that your favorite pitcher does not have to hear those three dreaded words: “rotator cuff tear.”

Please stay healthy, Matt Cain!