Overthrowing: Abnormal Shoulder MRIs In Young Baseball Players Without Shoulder Pain

By Dev Mishra, M.D., President, Sideline Sports Doc, Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • A recent medical study showed that more than 50% of throwing shoulders in young baseball players without shoulder pain had MRI abnormalities
  • These MRI issues have the potential to cause long term issues for the shoulder
  • Players who played more than 8 months out of the year and were baseball-only athletes had a 100% chance of an abnormal MRI, regardless of playing position

At least once a week I’ll see a young athlete in the clinic with shoulder pain and at theYouth Pitchers end of a careful discussion, physical exam, and further discussion with the parents I’ll hear “that’s great, now can he have his MRI this afternoon”. The desire for an MRI is normal and natural on the part of the parents, after all this is what the media tells us will happen in a professional athlete.

(And btw the truth of that interaction with a pro athlete is frequently very different than what’s reported). But this study, published about a month ago in the Orthopaedic Journal of Sports Medicine provides valuable insight. An alarmingly high number of non-painful throwing shoulders in young athletes will have MRI abnormalities compared to the athlete’s own non-throwing shoulder.

The shoulder is frequently injured in young baseball players. Sports medicine doctors will often treat these athletes for overuse injuries and structural problems. Many of these diagnoses have long-term implications, sometimes requiring surgery and putting young athletes at risk for future problems. You’d be far better off not having any of these conditions.

Author Andrew Pennock and colleagues from UC San Diego orthopaedic surgery performed the study. They performed MRI evaluations on 23 young male baseball players aged 10-12 with no reported shoulder issues, and did MRI scans on the throwing and non-throwing shoulder.

Here were some of their key findings from the MRI portion of the study:

  • 52% of the throwing shoulders had MRI abnormalities that were not present in the non-throwing shoulder
  • They identified 2 key risk factors: year round play (defined as 8 or more months of baseball play per year) and single sport specialization
  • If a player had 1 of the 2 risk factors there was a 71% chance of an abnormal MRI; and with 2 of 2 risk factors there was a 100% chance of an abnormal MRI
  • Player position did NOT correlate with an abnormal MRI, meaning that fielders could also have an abnormal MRI

There were also some interesting observations about player behavior and knowledge of rules and recommendations for shoulder safety. 83% of the players were aware of pitch count restrictions, innings restrictions, and PitchSmart recommendations, and yet it appears that the number of players who actually followed the recommendations was small. In this study, 43% played baseball more than 8 months per year, 22% were single-sport athletes, and 80% of pitchers threw curveballs, sliders, and sinkers.

There are some limitations to this study that require additional investigation. It’s a fairly small number of players, and we don’t actually know what happens down the line to the shoulders with abnormal MRI scans.Sideline Sports Doc Logo

If you’re parents or coaches of young baseball players please have a look at the guidelines and rules in place from Little League Baseball and PitchSmart, and then make a commitment to actually follow the rules. A healthy arm is much better for long-term health and near term performance.

Help For Elbow Injuries In Pitchers? A Prevention Program Offers Hope

By Dev Mishra, M.D., President, Sideline Sports Doc, Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • Overuse injuries to the elbow are common in young baseball players, and prevention programs are needed to reduce injury risk
  • A recently published scientific study highlighted the potential benefit of a stretching program called the Yokohama Baseball-9, showing a significant reduction in elbow injuries for players who used the program compared to those who didn’t
  • The program has the potential to be a useful tool in reducing numbers of elbow injuries for young baseball players

I’m a big believer in prevention programs for sports injury risk reduction and this week we’ll discuss a program to reduce elbow injury risk in baseball.

I’ve written before about the usefulness of the 11+ warmup program for lower extremity risk reduction in soccer. That program is highly effective. Prevention programs are great in theory but actually proving the usefulness can be difficult. What are required are often lengthy scientific studies with large numbers of individuals. Those types of studies have been done with the 11+ but are lacking for elbow injury prevention programs in baseball. But a recently published study from Japan offers some hope.

The study authors devised the Yokohama Baseball-9 (YB9) program, which consists of 9 flexibility exercises focused on the wrist, elbow, shoulder, and hips.

There were 275 players age 8 to 11 divided into a non-YB9 group and a YB9 group. Players were asked to complete the program at least once a week.

At 1-year, the YB9 exercise group had significantly lower rates of elbow injury and significantly better total range of motion at the shoulder. In a statistical analysis, increased shoulder total rotation, increased nondominant hip internal rotation and improved spine posture predicted lower rates of elbow injury.

This is a good study but there are some weaknesses. 28% of the original group was excluded due to prior shoulder or elbow pain and an additional 15% were lost to follow up. And it is a relatively small number of players who participated.

We need more studies like this so I hope it can be repeated by others, and with larger numbers of players. The fact that 28% of the young players in the original group of potential players were excluded because they already had pain in pretty alarming, and good evidence that we need some solutions to the problem of overuse injuries in baseball pitchers.Logo

Overall, the study is encouraging and provides an interesting new potential avenue for injury prevention.

Common Hand Injuries: Text Thumb; Little League Pitchers: Do’s & Don’ts; Importance of Sleep for Optimal Recovery

Episode 17.35 Rerun

Segment One (01:10): Dr. Nik Verma sitting in this week for Dr. Cole joins Steve andImage result for thumb overuse Nicole Kauppila from Athletico Physical Therapy to discuss Tech Thumb injury.

Each year as we approach the holidays, smartphones are listed as a top gift.  With use of smart phones – tech-related injuries called “tech-thumb” resulting from unnatural movements like constant texting are on the rise.

New smartphones often means even more time straining thumbs, in fact young adults spend a staggering one-third of their waking hours on smart phones. Nicole describes causes, symptoms, prevention and treatment for overuse injuries of the hand.


 Segment Two (11:46): Dr. Nik Verma, Head Team Physician for the Chicago White Sox talks with Steve about how to avoid overuse throwing injuries in young athletes; avoid training in one sport all year long, high pitch velocity and pitch counts that can cause damage from repetitive load on the growth plates of young athletes.

Image result for little league pitcher


Segment Three (20:14): Todd Sayer, PT from ATI Physical Therapy talks about the importance of sleep for optimal recovery; the correct supportive neutral sleep position; avoiding compressed shoulder joint in side sleepers.

How you sleep dictates how you perform, so whether you are falling short on logging enough sleep each night or poor sleep posture is inhibiting a solid day’s performance, making a few simple changes can help to enable a good night’s rest and support your body’s ability to adapt and adjust.

Todd Sayer  is a Senior Regional Director with ATI. He has 18 years of clinical experience specializing in treatment outpatient orthopedic and sports medicine injuries as well as chronic pain and post-operative care.

Overcoming Sleep Challenges and Discomfort