Shoulder pain is a very common complaint in baseball players, for both pitchers and position players all too regularly. Fortunately, the vast majority of these can be treated without surgery, and just require proper evaluation by a sports medicine physician who can then organize the treatment plan to get the athlete healthy again.
The most common source of shoulder pain in the baseball players that I see is impingement, which leads to the clinical condition known as bursitis. You may hear these terms used interchangeably, as they are trying to describe the same set of symptoms, but they do mean different things. Typically this is pain with the arm maximally elevated, or even any throwing position of maximal external rotation and abduction. This is also known as the “late cocking phase” for pitchers.
Most overhead throwing athletes have slightly more shoulder external rotation – with correspondingly less shoulder internal rotation – on their throwing arm compared to their non-dominant arm. It’s always interesting to show this to the athlete or family members in the office. Fortunately, proper focus on stretching of the posterior capsule to allow more shoulder internal rotation is a very helpful therapeutic step. When shoulder pain is quite bad, I frequently will use anti-inflammatory medications or a Cortisone injection to the shoulder as well. This can be very helpful not only to reduce the amount of pain, but also to shut down the inflammation. We typically recommend some time away from throwing to allow pain to subside as well.
Of course, there are other diagnoses – there can be biceps tendinitis, a small labral tear, a specific type of torn labrum known as a slap lesion, or even a partial small rotator cuff tear. These are less common and still surgery is not frequently necessary. I am very liberal about obtaining an MRI with contrast dye for shoulder as well as asking about other injuries in my baseball players.
If you are a baseball player having an ongoing shoulder issue, I recommend you see an Orthopedic surgeon who is a sports medicine specialist, preferably one with experience in treating baseball players.