Oklahoma State University, Nashville, Tenn.W3-0 Oklahoma State University in Nashville, Tenn.1:00 pm VSOklahoma State University in Nashville, Tenn. Oklahoma State University in Nashville, Tenn.1:00 pm VSOklahoma State University in Nashville, Tenn. The North Alabama VS North Carolina The city of Nashville, Tennessee, at 4:30 pm. VSEvansville The city of Nashville, Tennessee, at 4:30 pm. 4:45 p.m. (Eastern Standard Time) two-hundred-twenty-five (Tuesday, January 31st, 2013) VSCentral ArkansasNashville, Tennessee4:30 p.m.
11:00 pm to 10:35 pm Honolulu, Hawaii’s ATHawaii (DH) is an international airline.
the hour of 5:05 Hawai’I’s ATHawaii is located in Honolulu, Hawaii.
- VSWagnerVSWagner Vanderbilt UniversityVSWagnerNashville, Tennessee1:00 p.m The VSMichigan Orchestra will perform in Nashville, Tennessee, at 6:00 p.m.
- The VSMissouri team will play in Nashville, Tennessee at 6:00 p.m.
- MISSOULA, MISSOURI (VSMissouri) Nashville, Tennessee (VSMissouri) 2:00 p.m.
- on Saturday.
- at 6:15 p.m.
- 6:00 p.m.
- 1:00 p.m.
A Tennessee/First Horizon Park TLipscombNashville, Tenn.
(eastern time) Music City, Tenn.6:00 p.m.
At 7:00 p.m., VSTennessee will perform in Nashville, Tenn.
Music City, Tenn.6:00 p.m.Visit Austin Peay’s website.
(eastern time) 1:00 p.m.
WVWKNASHVILLE (Tennessee) 6:15 PM VSWestern Kentucky Tennessee State University (VSFlorida) Nashville (Tennessee) 5:30 pm Tennessee State University (VSFlorida) Nashville (Tennessee) 5:30 pm The VsFlorida game will take place in Nashville, Tennessee, at 12 pm.
At 6:00 p.m.
At 5:30 p.m.
Lexington, Kentucky11:01 am ATKTennisKentucky At 12:01 p.m.
The VSTexas A M game will take place in Nashville, Tennessee, on Friday, December 6th at 6:00 p.m.
At 5:45 pm, the clock strikes five.
in Nashville, Tenn.
(ATArkansas) Mid-Tennessee Valley State University Nashville, Tennessee 6:00 p.m. VSMiddle Tennessee at 6:15 p.m. (eastern time) at 6:15 p.m. (eastern time) two-hundred-twenty-five
The Disabled Throwing Shoulder- The “Dead Arm”
“Dead Arm” is a phrase that is commonly heard among athletes who compete in sports that require precise pitching, such as baseball. The phrase “dead arm” refers to any pathological shoulder ailment in which the thrower is unable to throw with the same velocity and control as before the injury as a result of discomfort. Dead arm is most commonly encountered during the acceleration phase. This occurs when the athlete’s arm is going forward and the athlete experiences immediate discomfort. The arm becomes “dead,” and the player is no longer able to throw the ball with the same velocity as before.
What Are The Causes?
It is classified as a condition with a variety of possible causes, known as the “Dead Arm” phenomena. Psychological factors, calcification in the ball and socket joint, and bone spurs in the acromion are just a few of the reasons that contribute to this condition. A “dead arm” can be caused by impingement of the shoulder ligaments, rotator cuff issues, bicep tendonitis, micro-instability, internal impingement, and a SLAP lesion, among other things.
What Happens In The “Dead Arm”?
It has been previously postulated that the pain in the throwing athletes’ shoulders is caused by the shoulder capsule in the front being over stretched as a result of the repetitive arm position being turned out backwards as far as possible (external rotation) to generate potential energy during the wind up phase prior to the forward acceleration phase. When the capsule becomes overly stretched, it causes the “ball” of the shoulder to slide forward, resulting in an impingement of the tissues in front of the shoulder joint, resulting in discomfort and the inability to throw.
- According to certain studies, the term “dead arm” is most frequently connected with Type 2SLAP (Superior Labral Tear from Anterior to Posterior) lesions of the shoulder.
- Type 2 SLAP lesion arises as a result of a tight posterior capsule capsule.
- The ball of the shoulder is forced upwards and backwards into the shoulder joint as a result of the tight capsule.
- This stiffness of the capsular ligament is shown as a lack of forward rotation (internal rotation) of the shoulder joint on the outside.
How Do I Know If I Have A “Dead Arm”?
Physiotherapist evaluating a paralyzed arm The following is a test to determine the range of forwards rotational motion. To begin, lie down and position your arm such that it is 90 degrees relative to your torso, with the elbow held at the same angle as the arm. Allowing the forearm to drop forward as much as possible while maintaining stability in the shoulder and preventing the shoulder blade from sliding up. In an ideal situation, you should be able to travel ahead approximately 90′. Everyone is unique in their own way.
According to one study, participants who had a loss of range of motion and performed stretching to the capsule experienced a 38 percent reduction in the occurrence of shoulder disorders.
The allowable loss of advancing rotation range, according to the researchers, is 20 degrees.
Are you suffering from arm pain?
Burkhart, S. S., Morgan, C. D., and Kibler, W. B. (references). The throwing shoulder in the disabled state: A spectrum of disease Pathoanatomy and biomechanics are covered in Part 1. The Journal of ARthoscopic and Related Surgery, Volume 19, Number 4, April 2003, Pages 404-420
Six Common Baseball Injuries: The Impact on a Pitcher’s Anatomy
Overuse injuries become a very real part of life for baseball players of all ages who participate frequently and at high levels of competition. Moreover, while a few particular disorders do tend to manifest themselves in hitters, the majority of baseball injuries occur in pitchers. Throughout this post, we’ll go through the six most commonly seen ailments among baseball pitchers and provide you with some suggestions on how to avoid and manage baseball injuries.
Six Common Baseball Injuries in Pitchers:
1. Oblique Muscular Strains: In recent years, Major League Baseball has had as many as 20+ players placed on the disabled list due to oblique muscle strains, which are a type of hamstring strain. Because the ability to spin the body abruptly and swiftly is a critical and repetitive component of a pitcher’s profession, this occurs frequently in the case of pitchers. 2. Labral tear: A labral tear is a shoulder injury that develops when the ring of fibrocartilage that surrounds the shoulder socket is ripped or ruptured.
- Many pitchers experience a “grabbing” sensation in the shoulder joint when the labrum loosens and the entire joint becomes unstable as a result of the loosening.
- Injuries to the rotator cuff: The rotator cuff is a collection of four muscles that work together to control the movement of the shoulder.
- Eventually, this disease, which is one of the most prevalent baseball injuries, can evolve to more serious tendonitis, which can necessitate a period of rest ranging from a few weeks to several months in most cases.
- 4.Shoulder instability: A pitcher may have what is referred to as “dead arm” from time to time.
- It is no longer possible to function normally when the muscles grow exhausted and the joint becomes unstable, which causes the shoulder to become dysfunctional.
- It is possible for the shoulder to dislocate or partially dislocate if the shoulder instability gets severe enough.
- This ligament can get stretched as a result of repetitive use or as a result of a physical injury to the elbow joint.
- Injuries to the anterior cruciate ligament (UCL) are among the most prevalent elbow baseball injuries that plague competitive pitchers.
- The damage can be treated with a method known as “Tommy John” surgery, which stands for Tommy John surgery.
- The discomfort is felt on the inside of the elbow and generally develops gradually as a result of misuse of the arm.
If any of the above-described ailments seem familiar to you, you should seek cautious therapy under the supervision of a sports medicine specialist to begin with. If the following therapies prove to be ineffective, speak with your doctor about more advanced treatment options for your condition.
Conservative Treatment for Common Baseball Injuries
- Aid in the stabilization of the damaged region by applying a support or splint to it Consider taking a break from playing or practicing for a specific length of time. Using ice to relieve pain might be helpful when an injury is acute. Using an elastic bandage, provide compression to the injured area as soon as possible after the incident. The act of elevating the afflicted area can aid to reduce swelling, which in turn can help to alleviate discomfort.
Take a few minutes to go over this useful resource from the American Orthopaedic Society for Sports Medicine, which will allow you to address some of the often asked questions:
- An elbow or shoulder injury is diagnosed in the following ways: What can be done to prevent and cure overuse injuries
- And The maximum pitch counts and rest intervals that are reasonable for each age group
- What are the suggested ages for players to begin using different types of fields
You may learn more about the sports medicine services offered at Rothman Orthopaedic Institute by visiting our website or calling us at 1-800-321-9999.
Inside Look: Dead Arm Syndrome
A bit more detail on what Jon Niese believes he is feeling and why the Mets are sending him back to New York for an MRI can be found at the link below. The following is a paraphrase of Wikipedia: Dead arm syndrome is characterized by repeated motion and stresses on the posterior capsule of the shoulder that cause the arm to fall asleep. The posterior capsule of the shoulder is a ring of fibrous tissue that binds the rotator cuff tendons to the bone of the shoulder. The rotator cuff is made up of four muscles and their associated tendons.
- Hypertrophy, which is a buildup of tissue around the posterior capsule as a result of overuse, can occur.
- This sort of condition restricts the amount of inward rotation the shoulder can perform.
- When the labrum is in place, the head of the humerus (upper arm) is more securely held in place in relation to the shoulder socket than when it is not there.
- The end result of all of these procedures is the phenomena known as the dead arm.
- Dead arm syndrome is not something that will go away on its own with rest; it is something that must be addressed.
- If the damage is discovered before it progresses to a SLAP rupture, physical treatment combined with stretching and exercise can help to recover it.
- According to Rowland-Smith, “you’re coming off an offseason when you had your own throwing program.” You arrive to camp and all of a sudden you’re throwing to bases and doing additional stuff.
You’re sweating it out as you play day game after day game.
All of these considerations come into play.” In addition, when the dog days of August arrive and teams are driving through in the latter stages of a 162-game regular-season grind, dead arm may reemerge and perhaps ruin a championship contender’s chances.
“Just pitch through it,” C.C.
It’s a lot easier said than done for a 6-foot-7, 280-pound perennial Cy Young candidate, but Linebrink believes Sabathia is on the money when it comes to addressing dead arm syndrome.
And here’s an extract from a story that appeared in the Wall Street Journal in 2011, which you can read in full here: Dr.
“It’s not a precise diagnosis,” says the doctor.
It’s possible that the damage and the associated instability in the shoulder are so minor that the pitcher will not feel any discomfort at all.
It is clear from the Wikipedia description that the term “pain” is never mentioned in the context of this explanation.
During the first several weeks of camp, when pitchers throw more than usual due to fielding practice and the Florida heat, this is a pretty frequent occurrence.
Pitching coaches and trainers are familiar with the indicators of a dead arm, so being referred for an MRI indicates that there may be more to it.
Michael Hausman pointed out in the Wall Street Journal piece. Keep checking back with MMO for the latest developments in the Niese case.
Overuse and Dead Arm Syndrome – Caring Medical Florida
The overhand throwing actions of three different categories of baseball players will be discussed in this article. The young athlete, the teenager nearing collegiate age athlete, the collegiate age athlete, and the professional level athlete are all categories of athletes. We have encountered many parents of youth athletes who have come into our clinics with a large medical file and a great deal of anger about the “lack of progress” their child is making in returning to their sport after being injured.
- The best time to seek therapy is not when your shoulder completely gives up, but rather when the discomfort first begins to appear.
- A pitcher who is experiencing shoulder discomfort should get his or her shoulder examined.
- Tendonitis of the rotator cuff in the shoulder is nearly typically caused by weak ligaments in the shoulder.
- In time, shoulder instability develops as a result of the injury.
- A prior Shoulder Dislocation may have resulted in this position, but it can also arise as a result of congenitally lax joints or from repetitive motion damage, such as that sustained when pitching.
Pain with abduction and external rotation (referred to as a Positive Apprehension Test), soreness to palpation across the shoulder joint, and a subjective sensation of weakness in the arm are all symptoms of joint instability and laxity that manifest themselves gradually over time (Dead Arm Syndrome).
- Using non-surgical methods to repair a SLAP rip
- Prolotherapy for the treatment of Rotator Cuff Tendinopathy Is it necessary to have surgery for a partial rotator cuff tear? Surgery on the Tommy John
- Shoulder dislocations, subluxations, and instability are common among the elderly.
Preventing dead arm and overuse in juries in youth baseball players starts with preventing overuse
Pitch count disputes in teenage and child baseball programs have erupted in recent years. “Youth pitchers remain at significant risk for shoulder and elbow overuse injuries despite well-established advice on pitch count limitations,” according to a recent study published in the Journal of Pediatric Orthopedics (Nov/Dec 2018). (1) The cooperation of the coach was what the researchers were looking for.
- In an anonymous 13-question survey, sixty-one (61) youth baseball coaches from neighboring suburban communities outside of two different Midwestern metropolitan towns were asked their thoughts on the sport. The majority of coaches stated the following:
- Coaching male players (89 percent, 54 of 61 coaches)
- Predominantly between the ages of 11 and 12 years (51 percent, 31 of 61 coaches)
- Mostly between the ages of 11 and 12 years (51 percent, 31 of 61 coaches)
- A total of 56 percent (34 of 61 coaches) stated that they “always” kept track of the number of pitches.
- 56 percent (34 of 61 coaches) said they “always” kept track of the number of pitches they threw
- When asked to accurately identify risk factors for overuse injuries, only 13 percent (8 of 61 coaches) could do so while also appreciating the need of off-season strengthening. Coaches reported sitting out an athlete because of an overuse injury 38 percent of the time (23 of 61 coaches), with the greatest percentages finding among those instructing the lowest (8U and under) and oldest (U17 and older) age groups. 15 percent of 61 coaches were non-compliant with age-based recommendations against throwing breaking pitches
- Nine of 61 coaches were non-compliant with age-based recommendations against throwing breaking pitches
CONCLUSIONS: “Knowledge of pitch count restrictions developed to minimize overuse injuries to the shoulder and elbow in youth pitchers continues to be lacking among the group of coaches assessed,” the researchers concluded. “MRI results in asymptomatic Major League Baseball pitchers do not appear to be associated with a likelihood of being placed on the disabled list in the near future.” However, there was a statistically significant difference in the number of innings pitched between pitchers who had an RCT (Rotator Cuff Tear) and those who did not, as well as a considerable association between the number of innings pitched and the existence of RCT as well as labral lesions.
This results lends credence to the hypothesis that Rotator Cuff Tear and labral damage in pitchers may be caused by repetitive overhead action, resulting in tension on the rotator cuff tendons and glenoid labrum, as previously reported.
1 Researchers have discovered that the prevalence of tears in the shoulder among pitchers who report no discomfort is higher than they previously believed to exist.
Rotator Cuff Tendonitis and Dead Arm Syndrome
Rotator Cuff Tendonitis is a secondary condition that can arise as a result of persistent shoulder instability (RCT). Rotator cuff tendonitis can occur when the muscles of the rotator cuff, which include the supraspinatus, infraspinatus, teres minor, and subscapularis, are overworked, causing the tendon to become inflamed and painful. It can also occur when the muscles of the rotator cuff are overworked, causing the tendon to become inflamed and painful. Generally speaking, RCT develops when a shoulder that has been chronically unstable for a long period of time puts undue strain on the shoulder’s muscles and tendon, particularly the rotator cuff muscles and tendon, when the shoulder swings through its complicated pitching motions.
Chronic ligamentous instability can result in rotator cuff tendonitis, however Prolotherapy can be used to treat both the instability itself and the secondary tendonitis that results as a result of the instability.
Tendonitis of the rotator cuff and impingement syndrome of the shoulder Rotator cuff tendonitis arises when the tiny muscles of the rotator cuff, the supraspinatus, infraspinatus, teres minor, and subscapularis, get strained, resulting in a loss of strength in these structures and the development of tendonitis in the process.
- Pitchers are more susceptible to rotator cuff tendinitis and impingement syndrome than other athletes because of the overhead movement required to pitch a baseball and because the rotator cuff is at its most vulnerable when in the throwing position.
- It is possible that the swelling in the tendon and bursa will be reduced as a result of the cortisone injection’s powerful anti-inflammatory qualities, therefore alleviating the symptoms.
- Constant irritation of the tendon caused by the impingement process over a long period of time may result in degenerative fraying and tearing of the tendon over time.
- Together with progressive reconditioning of the rotator cuff muscles, this provides a good opportunity for a full recovery and return to full function.
- 1 D.M.
- Continenza, K.Hoffman, and A.G.
- Journal of Pediatric Orthopaedics, published online first on November 1, 2018, is e623-8 (Google Scholar) One of the most recent studies was conducted by Lesniak BP and colleagues (Baraga MG, Jose J, Smith M, Cunningham S, and Kaplan LD).
The findings on magnetic resonance imaging of the glenohumerus correlate with the number of innings pitched in asymptomatic pitchers. 8761261 American Journal of Sports Medicine, published online June 17, 2013.
Dead Arm Syndrome: Symptoms, Causes, Treatment & Prevention
The shoulder is affected by dead arm syndrome, which is a disorder that affects the arm. It is brought on by frequent motions that put stress on the joint, resulting in pain. Over time, the shoulder becomes increasingly unstable, causing discomfort and agony in the surrounding region. For example, throwing a baseball or serving a tennis ball above might be difficult because to the restricted range of motion. If you participate in particular sports, you are more prone to get dead arm syndrome.
Continue reading if you’re interested in learning more about dead arm syndrome.
Dead arm syndrome is characterized by discomfort or weakness in the upper arm that occurs during a throwing motion.
It is possible that the disorder will cause your arm to feel limp or “dead” in addition to the discomfort and weakness.
- Stiffness, numbness, or tingling in the afflicted arm, weariness in the affected arm, reduced throwing speed, inability to throw with force, and impaired control while moving your shoulder are all symptoms of frozen shoulder.
Typically, misuse of the arm results in dead arm syndrome. Throwing, for example, is a repetitive exercise that can strain the ligaments in your shoulder. Ligaments are bands of connective tissue that hold bones together and provide support for joints. With time, the ligaments loosen and become unstable, resulting in shoulder instability and pain. When the rotator cuff tendons are damaged, it is possible to develop dead arm syndrome. This is the set of muscles and tendons that help to keep your upper arm bone in its proper position.
Throwing, on the other hand, can put a significant amount of strain on the shoulder.
When this is done frequently, it can cause injury to the rotator cuff tendons, resulting in dead arm syndrome (also known as frozen shoulder).
This includes those who conduct repetitive overhead actions, such as throwing, on a regular basis.
- Baseball pitchers, water polo players, tennis players, volleyball players, youthful athletes, and manual laborers are all examples of people that work hard.
The most effective way to treat dead arm syndrome is to improve the stability and strength of your shoulder. Depending on the degree of your injury and how frequently you conduct overhead motions, the appropriate method will be determined. The following treatments may be used:
- Rest. Regardless of whether you are experiencing minor or severe symptoms, it is critical that you minimize your activities. Exercise and physical therapy will help to keep your symptoms from getting worse. It is likely that you will want the services of a physical therapist when your shoulder begins to feel better. In addition, they may demonstrate how to perform shoulder strengthening exercises. Ice. Applying ice to your shoulder might assist to alleviate any discomfort. Anti-inflammatory medicines are used to treat inflammation. You can use anti-inflammatory medications, such as ibuprofen, to help alleviate the discomfort. Surgery. If none of the therapies listed above are effective, or if your symptoms are severe, you may require surgery. In most cases, a surgeon can restore the torn tendons and ligaments in your shoulder.
If you choose to have surgery, you will be required to wear a sling. Physical therapy will also begin about 4 to 6 weeks following your operation. Additionally, before you may resume your normal activities, your doctor will present you with a “return to play” program to follow. This program will assist you in gradually regaining strength in a safe manner. You should always get clearance from your doctor before returning to your usual activities, even if you do not require surgical intervention.
The length of time it takes for you to recover is determined on your symptoms.
However, if you have a severe injury or require surgery, it might take anything from 2 to 4 months or even up to a year.
To be sure, it might be tough to prevent overusing your shoulder, especially if you are a professional athlete, which is understandable. However, there are steps you may do to reduce your chances of being a victim. Take into consideration the following suggestions:
- Strengthening activities should be performed. By performing strengthening exercises, you can keep your core, upper back, and shoulders firm. Make use of the proper technique to aid in the improvement of shoulder stability. Take the time to become familiar with the proper technique for your sport. It is one of the most effective methods of reducing the risk of damage. Change your body’s posture. When at all feasible, experiment with different ways of doing overhead motions. This will aid in the reduction of repetitive stress on the shoulder. Stretching should be done on a regular basis. Follow a stretching regimen that has been tailored to your particular sport. Never forget to stretch and condition your body before and after any physical exercise. Rest. Allow your body to relax, especially if you have been engaged in strenuous activities. You should restrict the amount of throws your players make in a game or week if you’re a coach
Overuse of the arm results in dead arm syndrome. It happens when the muscles or tendons in the shoulder are injured as a result of frequent overhead actions, such as tossing a ball. Symptoms of dead arm syndrome include soreness, weakness, and numbness in the upper arm, which are all quite common. It is more likely that athletes who participate in activities such as baseball, tennis, and water polo would be affected by the ailment. Manual laborers who reach aloft on a regular basis are at greater risk of injury.
It is also necessary to perform strengthening exercises in order to enhance shoulder stability.
Exercises and stretches that strengthen your body will also assist to keep your shoulders in good shape.
Dead Arm Syndrome
“Dead Arm” is characterized by a sudden severe or ‘paralyzing’ pain that occurs when the shoulder is forced into a position of maximal external rotation in elevation or when it is subjected to a direct hit to the shoulder joint. Because of the discomfort and numbness, the patient is no longer able to make a throwing movement with the same level of control and velocity that he had before the injury. It is also referred to as recurrent transient subluxation of the shoulder in some circles. The dead arm syndrome is generally linked with anterior instability and a damaged anterior labrum, which is thought to be the result of dislocation of the humeral head in the shoulder joint.
- There are many distinct explanations for this behavior, which is classified as a disease.
- Instability of the shoulder joint or posterior capsular contracture may be a contributing factor to the development of the dead arm phenomenon.
- Psychological factors might also play a role in the development of this illness.
- The symptoms might be exacerbated if the posterior rollback is no longer present.
- There are two types of dead arm syndrome: those who are conscious of the subluxation and those who are not.
Epidemiology and Etiology
It is most typically observed in young athletes (aged 21-30 years) or in those whose arms have been powerfully hyperextended in elevation and external rotation of the shoulder during their sporting careers. It’s common among people who participate in repetitive throwing sports because the arm is repetitively turned out backwards as far as possible (external rotation) in order to generate potential energy during the wind up phase prior to the forward acceleration phase before the forward acceleration phase.
This causes the shoulder ball to migrate forward, impinging on tissues in the front of the shoulder joint, resulting in discomfort and an inability to throw as a result of the impingement.
It is frequently mistaken as another type of shoulder disease or as a cervical lesion, for example. There are a few characteristics that distinguish dead arm syndrome from the other types of shoulder dysfunction. It frequently manifests itself in the form of youthful, athletic adults (21-30 years). It also has a typical history of forceful overextension of the shoulder, as well as a positive apprehension test when the patient is relocated to another place.
When it comes to shoulder pathology or cervical lesion, it is frequently misdiagnosed. When compared to other types of shoulder impairment, there are specific characteristics that distinguish dead arm syndrome. It frequently manifests itself in the form of youthful, physically active adults (21-30 years). It also has a typical history of forceful overextension of the shoulder, as well as a positive apprehension test when the shoulder is relocated.
Management and Interventions
Physical therapy, similar to that recommended for shoulder instability and labrum injuries, is part of the treatment plan. It may be necessary to have surgery to rectify the instability as well as to repair damage to the glenoid labrum in the shoulder. An individualized return to throw program is implemented when the patient’s inflammation and discomfort have been alleviated. This process takes around 4 weeks. Before commencing strengthening activities, it is necessary to regain complete range of motion and flexibility.
This treatment, which should be followed for three to four months at a time, can help to reduce pain and impairment.
It is possible that it will progress to a full clinical picture of the posteo-superior impingement, including the formation of a SLAP lesion, in some cases.
SLAP lesions are fixed by arthroscopy; however, there are several distinct forms of SLAP lesions, and the type would dictate the best treatment approach for the individual patient.
- S.S. Burkhart, C.D. Morgan, and W.B. Kibler The throwing shoulder with a disability: a spectrum of pathologies Pathoanatomy and biomechanics are covered in Part I. O’Brien SJ, Arthroscopy 2003
- O’Brien SJ, Arthroscopy 2003
- 25(4):945-949. SLAP lesions are treated using a trans-rotator cuff technique. Technical elements of repair, as well as clinical follow-up of 31 patients for a minimum of two years, are being investigated. Pagnini MJ, Arthroscopy 2002
- Pagnini MJ, Pagnini MJ. Arthroscopic fixation of superior labral lesions with a biodegradable implant under fluoroscopic guidance. This is only a preliminary report. WARNER JJP, Arthroscopy 11:194-198, 1995. Reconstruction of Bankart superior labral anterior posterior lesions using an arthroscopy technique. Techniques and preliminary findings will be discussed. Arthroscopy 1994
- Ralph M. Buschbacher, Nathan D. Prahlow, M.D., and Shashank J. Dave, Sports Medicine and Rehabilitation 2009, p 59
- J Bone Joint Surg Am. 1981
- 63:863-872. 1.011.11.21.184.108.40.206.7CR Rowe and B Zarins, Recurrent transient subluxation of the shoulder Level of evidence: 2B
- 3.03.13.23.3 The role of the scapula in athletic shoulder function was first described by Drs. Richard B. Birrer, Bernard A. Griesemer, and Mary B. Cataletto in 2002, on page 348 of their book, Practical Orthopaedic Sports Medicine: Arthroscopy, and Donald H. Johnson in 2007
- Ho CY, The effectiveness of manual therapy in the management of musculoskeletal disorders of the shoulder: a systematic review
- Kibler WB, The role of 325-337 in the American Journal of Sports Medicine in 1998.
Dead arm syndrome – Wikipedia
Dead arm syndrome is characterized by repeated motion and stresses on the posterior capsule of the shoulder that cause the arm to fall asleep. The posterior capsule of the shoulder is a ring of fibrous tissue that binds the rotator cuff tendons to the bone of the shoulder. The rotator cuff is made up of four muscles and their associated tendons. They wrap around the exterior of the shoulder joint, holding it in place, protecting it, and allowing it to move. Hypertrophy, which is a buildup of tissue around the posterior capsule as a result of overuse, can occur.
- This sort of condition restricts the amount of inward rotation the shoulder can perform.
- When the labrum is in place, the head of the humerus (upper arm) is more securely held in place in relation to the shoulder socket than when it is not there.
- The end result of all of these procedures is the phenomena known as the dead arm.
- Dead arm syndrome is not something that will go away on its own with rest; it is something that must be addressed.
If the damage is discovered before it progresses to a SLAP rupture, physical treatment combined with stretching and exercise can help to recover it. It is frequent among baseball pitchers as they become older, and it may also occur among football quarterbacks and handball players as they get older.
- CR Rowe and B Zarins (July 1981). “Recurrent transient subluxation of the shoulder,” as the term is defined. J Bone Joint Surg Am.63(6): 863–72.doi: 10.2106/00004623-198163060-00001.PMID7240326
- Leffert RD, Gumley G. J Bone Joint Surg Am.63(6): 863–72.doi: 10.2106/00004623-198163060-00001. (October 1987). A study on the association between dead arm syndrome and thoracic outlet syndrome was published in 2010. The Journal of Clinical Orthopaedics and Related Research(223): 20–31.doi: 10.1097/00003086-198710000-00004.PMID3652577
- Blevins FT (September 1997). In the article “Rotator cuff pathology in athletes,” The American Journal of Sports Medicine, Vol. 24, No. 3, 1997, pp. 205–20. doi: 10.2165/00007256-199724030-00009.PMID9327536.S2CID44900729
- Ticker JB, Beim GM, Warner JJ (2000). In this paper, we describe the diagnosis and treatment of persistent posterior capsular contracture of the shoulder. Arthroscopy.16(1): 27–34.doi: 10.1016/S0749-8063(00)90124-5.PMID10627342
- Bach HG, Goldberg BA. Arthroscopy.16(1): 27–34.doi: 10.1016/S0749-8063(00)90124-5.PMID10627342 (May 2006). “Posterior capsular contracture of the shoulder,” as the name suggests. J Am Acad Orthop Surg.14(5): 265–77.doi: 10.5435/00124635-200605000-00002.PMID16675620.S2CID8915779
- J Am Acad Orthop Surg.14(5): 265–77.doi: 10.5435/00124635-200605000-00002.
Chris Sale and “dead arm”
By the 30th of July, 2012 I wrote about Chris Sale’s problematic elbow in mid-May, and I talked about valgus stress in the elbow as it applies to sidearm pitchers at the time. Currently, there are rumours that Sale will be stopped down for a start or two as a result of a “dead arm.” Well, I’m sure many of you are wondering.
What is dead arm, anyway?
Dead arm is a catch-all diagnosis for a pitcher who is losing velocity and/or command of their pitches and who is blaming it on weariness, according to Baseball Reference. From a physiological standpoint, there isn’t much to this diagnosis — it is more of a description of symptoms than a thorough investigation into the underlying reasons. Over the course of the year, Chris Sale’s velocity has progressively decreased: Furthermore, it’s worth remembering that Sale only pitched 71 innings out of the bullpen in 2011, and he’s already thrown 124 innings in 2012, which has been evenly split between the bullpen and the starting lineup (predominantly in the rotation, of course).
Three significant physiological changes occur as a result of pitchers throwing more and more innings at higher and higher game intensities: When pitching, they have a tendency to acquire external rotation range of motion around the shoulder joint while losing internal rotation at the same time.
-The ulnar collateral ligament (UCL), which connects the bones of the arm, can get stretched out while still keeping the bones together.
When a pitcher is stretched into internal rotation, most knowledgeable trainers will also provide exercises that passively engage the external rotators of the shoulder to help restore range of motion in IR and strength in ER without causing a concomitant “bounce” that occurs in late-cocking phase, which can help minimize issues with the first physiological change.
When it comes to the last alteration, there isn’t much that can be done — if your UCL is being stretched or gradually damaged as a result of bad mechanics, it necessitates a mechanical modification as well as more attention to pitching arm fitness.
So… what’s going to happen down the road?
Only the White Sox have the authority to decide how to proceed in this particular situation. While it may seem like a smart idea to take Sale out of the game for a few starts and then get him back into it, pitching isn’t something that can be easily dropped and picked up again — even if Sale is throwing bullpens and simulated games, participating in a game is a whole other activity. The fact that pitchers throw with greater energy and inflict more stress to their arms while pitching in competitive games as opposed to when pitching on the side has been shown time and time again via the publication of findings from various biomechanics labs.
- I’d keep him in the rotation, limit his innings this year (which is unlikely considering the AL Central playoff battle), and make minor adjustments in the off-season to address mechanical faults and build strength in his pitching arm in the hopes of avoiding problems in the future.
- Just because he isn’t reporting pain doesn’t rule out the possibility that he is hurt – lots of pitchers continue to throw while injured while showing no signs of discomfort.
- Kyle also owns Driveline Baseball and Driveline Biomechanics Research.
- Follow him on Twitter at @drivelinebases or send him an email at [email protected].
Eduardo Rodriguez and Dead Arm Syndrome
When the word got out of Boston a couple of weeks ago that scheduled Opening Day starter Eduardo Rodriguez would be sidelined indefinitely with Dead Arm Syndrome, everyone was shocked. In light of my forecast that the Boston Red Sox will complete the venerable worst to first streak by the year 2021, I interpreted the lefty’s injury as a little of karma (I really should have pounded on wood before writing that piece). While Eduardo Rodriguez appears to be on the mend, witnessing an athlete of his caliber suffer an injury like this should cause us to take a step back and contemplate how something as apparently innocuous as a fatigued or painful arm might presage more serious problems down the line.
“The Great Unknown”
Alex Cora explains why Eduardo Rodriguez will no longer be the Red Sox’s Opening Day starter on April 1, as previously announced. EduardoRodriguez| AlexCora| RedSox|—NESN (@NESN)March 26, 2021 EduardoRodriguez| AlexCora| RedSox Dead Arm Syndrome, like the yips, is one of those bizarre phenomena that occur in baseball. It is clear that the long-term repercussions of this damage will be quite diverse. It’s possible that the injury will be worth little to nothing. Take a few days off and you’ll feel much better when the inflammation in your shoulder has subsided a little bit more.
- That difference is what has me concerned about Eduardo Rodriguez’s (and the whole Red Sox organization’s) prospects for the upcoming season and, maybe, beyond.
- In response to these cues, your body responds by immediately decelerating your arm, sapping the velocity and spin given to the ball.
- If you have a “dead arm,” one of the most debilitating consequences is numbness in your fingertips (hard luck managing a throw while your fingers are numb).
- Because of this ambiguity, we are more likely to underestimate the severity of the injury (e.g., “Well, if it’s just a widespread ache, it can’t be that serious of an injury, right?”).
- After reading the long list of adverse effects associated with a “dead arm,” it’s easy to see why a pitcher would be rendered ineffective.
- A former Atlanta Braves reliever named Mike Gonzalez, who played for the team in 2007, comes to mind as an example.
- Amazingly, he avoided being pummeled, which is likely due to the fact that the current scouting report on Gonzalez is that he sits 93-95 degrees with his heater.
After all, it turns out that Gonzalez was pitching while suffering from a partly torn UCL, necessitating Tommy John surgery shortly after. During that period of time known as the “dead arm,” it is possible that anything is significantly wrong behind the hood.
Eduardo Rodriguez Moving Forward
What does this imply for Eduardo Rodriguez, and how will it affect him? He appeared to be in good health upon his return this past Thursday (5 innings, 3 runs allowed, 7 Ks). Most likely, a few additional days of sleep were all that was required. In a close AL East, and considering the fact that the Red Sox are a club that relies on scoring runs (and plenty of them) in order to contend, losing Rodriguez might have had significant ramifications for the team. It might be the difference between fighting for the division title and slugging it out in the division’s bottom half, depending on the situation.
Not every club can be as successful as the Washington Nationals in 2019, who won the World Series despite starting the season with a record of 19-31.
A Personal Connection to This Topic
The ramifications of this for Eduardo Rodriguez are unclear. When he returned to the team this past Thursday, he appeared to be in good health (5 innings, 3 runs allowed, 7 Ks). Perhaps a few additional days of recuperation were all that was required. It’s possible that losing Rodriguez would have had significant ramifications in the AL East, considering the fact that the Red Sox are a club that relies on scoring runs (and plenty of them) in order to contend. For other teams, it might be the difference between vying for the division title and fighting for survival in the division’s cellar.
The ’19 Washington Nationals, who finished the season with a record of 19-31, were not every team’s dream come true.
Shoulder Injuries in the Throwing Athlete – OrthoInfo – AAOS
Overhead throwing puts a tremendous amount of strain on the shoulder, particularly on the anatomy that holds the shoulder in its stable position. Because these high pressures are repeated over and over again in throwing athletes, they can result in a wide variety of overuse injuries. Although throwing injuries to the shoulder are most typically observed in baseball pitchers, they can occur in any athlete who engages in sports that demand repetitive overhead motions, such as volleyball, tennis, and several track and field events, as well as in other sports.
- Your shoulder is a ball-and-socket joint (clavicle).
- The glenoid is the name given to this socket.
- The labrum contributes to the deepening of the socket and the stabilization of the shoulder joint.
- The shoulder capsule, a thick band of connective tissue that surrounds the head of the upper arm bone and maintains it oriented in the glenoid socket, serves as the ligament system for the shoulder.
- Your shoulder is also supported by strong tendons and muscles, which help to maintain its stability.
- Rotator cuff syndrome is caused by four muscles that join together as tendons to produce a covering of tissue that surrounds the head of the humerus, which is known as the glenoid.
- The top of the shoulder socket is where the long head is attached (glenoid).
- In addition to the ligaments and rotator cuff, the muscles in the upper back play a vital role in maintaining the stability of the shoulder joint.
- They have control over the scapula and clavicle bones, which together form the shoulder girdle, which serves as the structural basis for the shoulder joint.
The late cocking and follow-through stages of the pitching action exert the most amount of stress on the shoulder among the five phases that make up the pitching motion.
- Phase of late cocking. Throwers must raise their arm and hand over their heads and behind their bodies in order to achieve maximum pitch speed. This arm posture with high external rotation aids the thrower in getting the ball to go faster
- Nevertheless, it presses the head of the humerus forward, putting substantial strain on the ligaments at the front of the shoulder. After some time, the ligaments become more lax, allowing for more external rotation and faster pitching speed, but at the expense of shoulder stability. Phase of implementation and follow-up. As a result of the acceleration, the arm spins fast inside. Follow-through starts once the ball is released, and the ligaments and rotator-cuff muscles at the rear of the shoulder must absorb large loads in order to decelerate the arm and maintain control over its position.
When one component, like as the ligament system, gets weaker as a result of repeated stressors, other structures must step in to take on the additional strain. As a result, the throwing athlete is susceptible to a wide range of shoulder ailments as a result of this. The rotator cuff and labrum are the shoulder components that are most susceptible to injury when throwing a ball.
SLAP Tears (Superior Labrum Anterior to Posterior)
A SLAP injury occurs when the top (superior) section of the labrum is torn or ruptured. This is also the location where the long head of the biceps tendon joins to the labrum at the top of the shoulder. It is possible to have a SLAP rupture at both the front (anterior) and the back (posterior) of this attachment site. The most common symptoms include a catching or locking feeling, as well as discomfort when performing particular shoulder motions. It is also typical to have pain deep within the shoulder or with specific arm postures, such as late-cocking.
Bicep Tendinitis and Tendon Tears
The upper biceps tendon can become inflamed and irritated as a result of repetitive tossing. Biceps tendinitis is the medical term for this condition. Biceps tendinitis is characterized by symptoms such as pain in the front of the shoulder and weakness. A tear can occur as a result of the damage to the tendon induced by tendinitis on rare occasions. A torn biceps tendon can produce a strong discomfort in the upper arm that comes on suddenly. There may be a popping or breaking sound heard as the tendon tears in some persons.
Rotator Cuff Tendinitis and Tears
It is possible for a muscle or tendon to become inflamed when it has been overused. Throwers typically have irritation of the rotator cuff, which results in tendinitis. Pain radiating from the front of the shoulder to the side of the arm is one of the first signs of the condition. Pain may be experienced when throwing or participating in other activities, as well as during rest. As the condition advances, the athlete may begin to endure nighttime discomfort as well as a loss of strength and range of movement.
- As the deterioration progresses, the tendon may begin to rupture.
- The supraspinatus tendon is where the majority of tears occur in throwing athletes.
- Between the rotator cuff and the bone on the top of your shoulder lies a lubricating sac known as a bursa, which helps to reduce friction and irritation (acromion).
- When the rotator cuff tendons are torn or damaged, this bursa can become inflamed and uncomfortable as a result of the injury or damage.
Overhand throws can result in pinched rotator cuff tendons at the rear of the shoulder due to the interaction of the humeral head and the glenoid during the cocking phase of the throw. Internal impingement is the term used to describe this condition, which can result in a partial tearing of the rotator cuff tendon.
Internal impingement can also cause injury to the labrum, resulting in a portion of it peeling away from the glenoid bone. Internal impingement may be caused by a combination of looseness in the structures at the front of the joint and tightness in the structures at the rear of the joint.
When the head of the humerus slides out of the shoulder socket, this is referred to as shoulder instability (dislocation). Chronic shoulder instability is defined as a condition in which the shoulder is loose and slips out of position on a regular basis. In throwers, instability develops gradually over time as a result of years of continuous throwing that strains the ligaments and causes increasing laxity in the joint capsule (looseness). Subluxation occurs when the shoulder moves slightly off-center (subluxation) during the throwing action because the rotator cuff structures are unable to maintain control over the laxity.
On rare occasions, the thrower may notice that his or her arm has “gone lifeless.” Many years ago, the phrase “dead arm syndrome” was used to describe a state of instability.
Glenohumeral Internal Rotation Deficit (GIRD)
For the same reasons as previously stated, the severe external rotation necessary to throw at high speeds often causes stretching and loosening of the ligaments near the front of the shoulder. It is a normal and common consequence of this to have tightening of the soft tissues at the rear of the shoulder, which results in loss of internal rotation. Throwers are more susceptible to labral and rotator cuff injuries as a result of this reduction in internal rotation.
Scapular Rotation Dysfunction (SICK Scapula)
For the same reasons as previously stated, the excessive external rotation necessary to throw at high speeds can cause stretching and loosening of the ligaments at the front of the shoulder. It is a normal and common consequence of this to have tightening of the soft tissues at the rear of the shoulder, which results in decreased internal rotation. Throwers are more susceptible to labral and rotator cuff injuries as a result of this lack of internal rotation.
Medical History and Physical Examination
Discussions regarding your general medical condition, symptoms and when they first appeared, and the kind and frequency of sports involvement are all part of the initial doctor visit’s medical history element, which takes place at the first appointment. During the physical examination, your doctor will examine your shoulder to determine its range of motion, strength, and stability, among other things. In some cases, they may do particular tests on you, such as putting your arm in various positions to simulate your symptoms.
Discussions regarding your general medical condition, symptoms and when they first appeared, and the kind and frequency of sports involvement are all part of the initial doctor visit’s medical history element, which takes place during the first appointment. While performing a physical examination on you, your doctor will examine your shoulder to see how much mobility it has, how strong it is, and how stable it is.
If necessary, they may do particular tests on you, such as positioning your arm in various positions to simulate your symptoms. The findings of these tests assist the clinician in determining if more shoulder testing or imaging is required.
In many situations, nonsurgical therapy is the first line of defense against a throwing injury to the shoulder. Treatment options may include the following:
- Modification of one’s activity. In the beginning, your doctor may prescribe just altering your daily routine and avoiding things that aggravate your symptoms
- For example, ice. In order to minimize any swelling, ice packs should be applied to the shoulder. Nonsteroidal anti-inflammatory medications (NSAIDs) (NSAIDs). Pain and inflammation can be relieved using anti-inflammatory medications such as aspirin, ibuprofen, and naproxen. Alternatively, they can be obtained without a prescription or purchased over-the-counter. Physical therapy is a type of treatment that involves the movement of the body. Your doctor may prescribe particular exercises to help you increase the range of motion in your shoulder and strengthen the muscles that support the joint, according to your needs. Physical therapy can be used to target muscle and ligament stiffness in the rear of the shoulder and to assist strengthen the structures in the front of the shoulder, according to the American Physical Therapy Association. If you have a damaged structure, such as the labrum or rotator cuff tendon, this can help ease some of the load on it. Position has been switched. Body posture that places an excessive amount of stress on damaged shoulder components might be assessed in order to improve throwing mechanics. A change in posture or even a change in sport might alleviate recurrent strains on the shoulder and give long-term comfort, although it’s not always desired, especially in high-level players
- Cortisone shot If rest, drugs, and physical therapy are ineffective in relieving your pain, an injection of a local anesthetic and a cortisone preparation may be administered to you. Cortisone is a powerful anti-inflammatory medication that has been used for centuries. Injecting it into the bursa beneath the acromion can give pain relief for tears or other structural damage
- However, this is not recommended.
In some cases, your doctor may prescribe surgery based on the information you provide during your history, physical examination, and imaging exams, or if nonsurgical therapy does not alleviate your symptoms. The sort of surgery that is performed will be determined by a number of criteria, including your injuries, age, and anatomical structure. Your orthopaedic surgeon will consult with you to choose the most appropriate technique for your specific health needs. Arthroscopy. Fortunately, arthroscopic surgery may be used to treat the vast majority of throwing injuries.
The images captured by the camera are shown on a television screen, and the surgeon utilizes these images to guide small surgical tools during surgery.
During an arthroscopy procedure, your doctor can repair damage to soft tissues, such as the labrum, ligaments, or rotator cuff, that have occurred in the shoulder.
It is possible that a standard open surgical incision (a few millimeters long) will be necessary to treat the damage.
For a short length of time, you will most likely need to wear a sling to restrict your arm from moving around.
Your doctor may decide to remove the sling as soon as you are comfortable doing so in order to begin a physical therapy program.
Gentle shoulder stretches will help to enhance your range of motion and avoid stiffness in your shoulder joint.
This usually occurs 4 to 6 weeks after the procedure has taken place.
Your doctor or physical therapist will take you through a rehabilitation regimen that involves a gradual return to throwing if your objective is to resume overhead sports activities.
In recent years, there has been a greater emphasis placed on avoiding shoulder injuries sustained during throwing.
By performing adequate stretching and strengthening exercises for the upper back and torso (core), throwers may help to keep their shoulder girdle in excellent working order.
Pitching standards for younger athletes, including pitch count limitations and minimum rest suggestions, have been devised in order to save youngsters from becoming hurt.