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February 28, 2014

High school pitcher injures his arm — what’s next?

Q. My son is a 17- year-old baseball player who hurt his right shoulder. Last season he was an infielder but this season he became a pitcher. About a month ago, he injured his right shoulder while throwing. The injury took about a week to happen and we rested it for a week and it still bothered him and we saw our pediatrician.

Q.My son is a 17- year-old baseball player who hurt his right shoulder. Last season he was an infielder but this season he became a pitcher. About a month ago, he injured his right shoulder while throwing. The injury took about a week to happen and we rested it for a week and it still bothered him and we saw our pediatrician.

The pediatrician got an MRI scan, which showed a tear of the subscapularis muscle and he was sent to physical therapy. After about two weeks he went back to throwing but the shoulder again became sore and he was unable to pitch.

I then brought him to an orthopedic surgeon who said he needed to rest the shoulder for a couple of months and we are concerned that he is going to miss this baseball season. Does this sound like the right treatment and what can we do to get him to play sooner?

A. There are four muscles that make up the rotator cuff tendon that allow us to rotate the shoulder. The subscapularis portion of the rotator cuff tendon is less frequently injured and it is an internal rotator of the shoulder. In the throwing athlete, it is usually the tendinous portion of the subscapularis where it attaches to bone that is injured. If a significant subscapularis tendon tear occurs, it often requires arthroscopic surgical repair and a period where he can’t throw from six months to one year.

Your son appears to have a less common injury, which is a tear of the muscular portion of the subscapularis. Muscle tears can result in pain and weakness and usually require a significant period of rest and physical therapy for them to get better. Usually muscle tears will heal non-surgically.

After a period of rest to decrease the inflammation and swelling, the patient gradually works to restore normal motion and then works on a gradual strengthening program. It is common for this injury to take at least several months to heal. I do agree that this baseball season may be in jeopardy for your son.

If you are unsure of the diagnosis or timeframe, you may want to discuss this further with your current doctor or get a second orthopedic surgical opinion.

When your son returns to playing, it is very important that proper warm-up and conditioning is emphasized as well as proper throwing mechanics to decrease the risk of re-injury in the future.

Dr. Harlan Selesnick is team physician of the Miami Heat and director of Miami Sports Medicine Fellowship, Doctors Hospital. Send your questions to HarlanS@baptisthealth.net

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