Brian Schiff’s Blog

son is almost 6 months post op flat ground started this weak and I would say he is sitting mid to upper 70’s at 1/2 speed he does have some soreness after throwing but goes away after 1 day of rest do you think that is ok? or should he not have any soreness doing 15 minutes of warm up and about 30 pitches

Jim,

If the soreness goes completely away in 24 hours or less, than it is probably okay. However, I would monitor it very closely as he should really feel more and more comfortable with throwing the more he works past the surgery. That is not to say he won’t feel any fatigue or soreness, but do not let him rush back or push through pain if it is lingering.

My 17yo son just finished 3 weeks of therapy for Gird , in his last session they measured his ROM and he was at 85% which was great according to our therapist. He began his throwing program today and it went well. He did say it was hard finding his throwing angle and he felt a little wild.Is this common and when he begins to throw off the mound will he see a decrease in velocity at first?

Tim,

Hopefully his total shoulder ROM was within 5 degrees of his uninvolved side, as this is really what we want to see. Depending on how long it has been since he last threw, it is not necessarily uncommon for him to feel a little off. My throwers who have been dealing with pain often anticipate pain when they go back and if they adopted a compensatory arm slot, they may default to that. Once pain free, they need a little time to find their normal rhythm again. As far as velocity, I cannot tell you he will see a decrease or not. If he has a drop in velo, it may be more due to him unconsciously holding back as his brain may anticipate some pain versus a true loss in power. Hope that all makes sense.

What do you think the outcomes for elite position players are after shoulder surgery? Do they return to the same level with regard to throwing velocity & bat speed? MRI scheduled for suspected posterior labral tear from swinging a bat. Hoping to play this college season in Feb/March.

Position players actually fare better non operatively than pitchers and should also do well after surgery. I would expect a full recovery assuming surgery is successful followed by good rehab. Interval throwing usually begins around 4 to 4.5 months and unrestricted throwing 6-8 weeks later in many cases for position players provided everything foes smoothly. I would expect bat speed to return as well. There is always the metal side of recovery that factors in and this is an “X” factor if you will.

son returned to mound after about 1 year after labral tear did have small amount of soreness right after but went away 2 hours later coach has him throwing 1 30 pitch bullpen a week and about 20 pitches in inter squad game does that seem ok almost 7 months post surgery

Should be okay and just monitor soreness to ensure it is not increasing

Hello Brian. Great info. Thank you! My son is a d1 lhp who just had a labrum debridement 10 days ago due to months of some pain while throwing and velo decrease. I see info and stats on returning to former level with SLAP tears but this was a posterior tear/fraying at he 10-11 oclock position. Biceps tendon was intact with no labral detachment. Undersurface of the rator cuff was intact. There was a slight tearing of the posterior capsule posterior to the glenoid and extensive bersitis in the acromial space that the surgeon said would self repair with the mandated rest and rehab. Labral tissue was debrided and a 5mm undersurface of the acromian was resected using a bur. Tampa Bay Rays surgeon said it was a “hangnail” of a labrum tear. Thoughts on rehab, recovery and return to level of competition?

Hi Mark,

Thanks for reaching out. My son is a 14 y/o lhp with aspirations to play d1. I think this scenario sets up much better for your son than a SLAP injury. I find posterior labral repairs do better, and in this case your son had a debridement with no cuff issues. Once the soreness and inflammation from the bony work and surgery subside, he should do well. I would expect him to make a full recovery and get his velo back, but no way to predict for sure until he works back through it. If you saw the Rays surgeon, I am sure you are lining up good rehab as well. I have spoken to Rays ATC before and they have a good medical team down there.

Thanks Brian. I appreciate the feedback. Our challenge is that he is back in MI with us rather than rehabbing down in FL. Trying to find a PT in the Grand Rapids, MI area with experience rehabbing elite pitchers post labrum surgery is tough. If you know of anyone, please advise. Good luck to your son. LHPs that throw above 85 are a valuable commodity. I would encourage you to not leave the recruiting process up to other people (coaches, etc) unless you have a special one. A simple email to a coach that you have a lhp, opens doors. Thanks again.

You are welcome. I do not have any contacts up there. Hopefully things work out for my son. He is throwing close to 80 now. Just need to keep him healthy.

Hi, my daughter is a 16 year old softball player who has been playing for 10 years.she played a whole high school season and competive travelball summer season before going to the doctor for shoulder pain. We found out that she had shoulder dyskinisks, impigment syndrome, repetitive posterior dislocation, and shoulder compression. She has been doing phyisical therapy for 3 months 3 times a week and hasn’t thrown a ball since July. We haven’t seen any change in her stability but her mobility is almost back and she is getting stronger. Is surgery a must?

Hi Caitlyn,

If her shoulder is unstable and the dynamic strengthening fails to alleviate pain and more importantly allow for normal throwing, then it may be necessary at her age. Her position also factors in as outfielders and the catcher often have more stress on their shoulder followed by the left side of the infield. Once I see inflammation subside in rehab, I work on an interval throwing program to assess progress, but I also have space to do that in my clinic and not everyone does or has the experience with it. At some point, that becomes the real test.

My son had surgery in June ’16 and had two anchors put in. He started to throw from 60 feet a couple of weeks ago. He still has pain. Is there anywhere we can get information on what to expect and what pain or discomfort should be expected?

Hi Andy,

Is he doing the throwing in a supervised program with a specific progression? In other words, is it spelled out over a 4-6 week period with number of throws and distance as it goes? I think some soreness in the shoulder may be expected as he gets back to full throwing, but it should be mild and resolve in 24 hours or less in my opinion. He should not have any sharp pain during the throwing. It would be reasonable to expect he may have a few episodes where it feels more sore than others as he increases distance and eventually velocity. The key is to be very systematic in his approach while advancing based on what the shoulder tells you.

Brian, thanks for the forum. We live in Florida where my 16 year old son has been playing baseball since he was 5, pretty much year around. He plays for a pretty elite HS and also a well known Summer team in our area. He is a two way player and last year towards the end of the HS season, he felt some discomfort in his arm so we had him checked out. Long story short, he had labrum surgery on June 14th of this year. After 3 months of PT twice a week, we received clearance from his doctor to start Dr, Andrews Interval Throwing Program which we started on Sept, 14th. We had some hurdles and walls to push through at a few points, but here we are now starting Phase 2 of the program where he is throwing off the mound. Last year as a Sophomore, he was throwing mid 80’s. So far, he feels great, has no pain and seems to be throwing currently mid 70’s and we just started phase 2 where he is supposed to be throwing 50%. So far, things seem to be going well for him and he appears to be on track. I hear so many stories of kids not making it back to their previous levels of play. Are there also success stories of kids that did? If so, I’d like to hear some of those because our hope is that he will be ready for the Spring Season. Are we being unrealistic?

Hi Emilio,

Was it a SLAP tear or posterior labral tear? SLAP tear is a tougher one to make it back to previous level of performance for pitchers, but it is possible. I do think a complete recovery may take 9-12 months which would put him in the March time frame to be at 9 months. I think the key is to make sure he continues with scapular/cuff strengthening while maintaining shoulder ROM. Getting full external rotation after surgery can be a challenge after labral repair which can affect cocking or lay back position. I would say continue to be cautious and not push the throwing program any faster than his arm allows. I think there is a reasonable chance he can be pitching this Spring, but hard to say if he will be back to 100% or not. Remind him it is a process and to be patient with the recovery.

Initially they thought it was a SLAP tear, but when they went in it was not. He does have anchors and they also cleaned up his rotator cuff while they were in there. We threw again today (45 pitches) and he looked great. He says he feels good and he will continue to strengthen his shoulder area with band work etc. He also plays 3rd base and when we do our warm up throws prior to pitching, we end up where he is making throws from 3rd to 1st. Do you think that it’s reasonable to expect him to start at 3rd base this season until he is at 100% to be able to pitch? His throws from 3rd to 1st look pretty good now. I would imaging by the time the season starts it will only get better.

Seems reasonable enough. Just make sure he is honest with you and his coach about how the shoulder feels so he does not push through too much soreness or throw when his arm is fatigued.

My 16 year old daughter’s injury was a superior glenoid lumbrum lesion to right shoulder and had labdum surgery last November.

We’ve decided to take her out of pitching from here on. After she was cleared for field throwing we ogradually began doing high arc short toss and a later light bat swinging with dr and pt ok with only normal stress feelings and she has been looking good.

But recently we started occasionally throwing 60′ hard no arch and she started feeling a sharp pain upon release of throwing the ball. If she throws without a ball no pain. Pain seems to be all thru shoulder area.

We stopped throwing altogether until the pain goes away and know why and what we may need to do. I don’t want her to throw again until we know what this is and how to deal with it.

After kt tape, icing and rest I’d like to know if this is a normal feeling in recovery and what do we need to be doing or stop doing so we can get her back to throwing.

Please your input on how to approach this is desperately needed.

Mike

Mike,

Pain with throwing is always a concern. You say it is all through the shoulder and not
In the front? Is she still doing arm care exercises? How long has she been throwing?

Brian, please ignore my previous post and if possible replace it with this updated one below with more info.

My 16 year old daughter’s softball pitching injury was a superior glenoid labrum lesion to the right shoulder and underwent labrum surgery last November of 2016, it included two anchors. We’ve taken her out of pitching from here on and are concentrating on her other fielding positions.

After she was cleared for field throwing in May we gradually began doing high arc short toss, and later a light bat swinging with Dr. and PT approval, experiencing only normal soreness feelings from 24-48 hours.

We recently began occasionally integrating throwing from 60 ft, hard, no arch. But after a practice or two she started feeling a tightening pain in her shoulder on release when throwing the ball overhand, it lasted for about ten seconds.

After this feeling started she now feels the pain after practice even at rest producing a pinching sensation in her shoulder that has now lasted for the past 6 days.

We stoped all throwing for now and have put muscle relaxing KT tape, ice, streaching and rest on the shoulder and will stop using the arm for any serious activity until this pinching sensation stops and we find out why or how it started.

If she throws without a ball, moving her shoulder in the motion of throwing a ball there is no pain. When throwing with a ball after the pain starts the feeling seems to be towards the front of the shoulder deep near the top of bicep feeling twisted, tightened and pulled, creating the pain.

I don’t want her to throw again until we know what we did or did not do to produce this or is this part of the process and if so how to deal with it.

Please your professional input on this issue is desperately needed. Any links to video we can use to treat this would be a plus as well.

Thank you and let me know what I can do for you.

Mike & Katie

Hi Mike and Katie,

I would rest for now and see your PT or MD for follow-up. She may just have some cuff or biceps irritation, but a thorough orthopedic eval will help. Need to make sure her total shoulder motion is where it should be as well, as if she happens to have any internal impingement, this can cause rubbing or irritation of the cuff/labrum. Icing and resuming arm care exercises would be prudent as well. She should not have pain during throwing, so keep that in mind when she does begin to ease back into it.

Brian,

Thanks so much for the recommendation. Your reply has given us an idea for now where we may have gone wrong in our approach. As we all know the basic healthy throw must be approached with the elbow above the shoulders. My daughter’s range and degrees of motion should be open at that range and time to begin integrating throwing harder. Even though her pt visits were over my daughter’s range of motion was a little short of that and that’s where I think we may have gone wrong. Thanks again for your input it definitely shed some light.

Mike,

Glad I could help. Good luck!

Brian, I have a question I hope you can answer? Five years ago I had a right arm bicep tenodesis done and the results were good. The other day when playing golf it was strained and the pain is located in the humorous groove. I haven’t a Popeye muscle but it feels like it let go. I’m 56 years old and my thought is if it has let go I’ll just live with it and not go under the knife. Can it let go and still not look like I have a popeye?
Thank you

John,

You may have torn some scar tissue or it is possible you injured the biceps and it did not completely tear free. It may eventually tear completely if the latter is true. Your function should not really be greatly impacted either way. Use pain as your guide and follow-up with your surgeon if you want a definitive assessment.

Brian, I first posted to this forum in November of 2016. After my sons Sophomore season of HS baseball, he was feeling discomfort in his shoulder. As a pitcher, I thought it was important to get an MRI. The MRI revealed a tear in his labrum, as well as issues with his bicep tendon which all were corrected with surgery. He missed Summer travel ball last Summer as he rehabbed his shoulder. We followed the rehab to a tee, especially the throwing portion of the program. He was able to play HS baseball in the Spring, although his velocity was not where it was pre-surgery. All throughout, he continued to work hard to strengthen not only his shoulder, but his body. This Summer, he was able to play travel baseball. A little more than 12 months after surgery, he was offered a baseball scholarship at a D1 school to pitch. He is now committed to play baseball in college entering his Senior year of HS. I say all of the above not to brag on my son, but to give kids and parents hope that are going through a similar situation. I remember when we were going through this over a year ago, when I would attempt to do research on the surgery, the recovery time, the chances of coming back etc. 95% of what I found was negative, with very few positive stories about this injury as it related to baseball players. I want people that are going through this with their child, to never give up. Work hard, stick to the rehab program and to listen to their bodies. There were times during the throwing portion of rehab where he was feeling some discomfort or stiffness so we just stopped, and picked back up a couple days later. I never pushed him….There were good days, and there were bad days but we worked through it together. It strengthened our relationship in the end and I couldn’t be more happy for him to achieve his dream of playing College Baseball. Along with all of the above, there was lots of prayer involved too, I didn’t want to leave that part out 🙂

Emilio,

Thanks for sharing. So many people need to hear about the good stories like this. Congrats to you and your son! What a great ending, and best wishes for a healthy season and future!

Hi Brian,

I’m going in for surgery to repair what my MRI says is a soft tissue Bankart injury, with an anterior, inferior glenoid tear with thickening of the glenoid labrum and gadolinium cleft. Mumbo jumbo to me. My shoulder has subluxed about 10 times since I returned to pitching and playing shortstop in 2013. Each time the recovery period is a little longer, a little more painful. The throws in the whole from short have been the culprit the last two years. My pain post injury, is usually concentrated in the lower lat. My surgeon says he can repair what’s on the MRI but is vague – at least to me – as to whether this surgery will fix the instability problem. I’m 46, play competitive ball 2-3 times a week and pitch about 50 innings per season.

Thanks Brian

aaa

Mike,

Sounds like you will be getting a Bankart repair to tighten the shoulder and he may do a capsular shift or essentially pull things up to tighten the inferior capsule if it is too loose as well. Challenge is getting your full external rotation back after this to throw normally again. There is a delicate balance between mobility and stability required to throw. Pitching again will take some time. Therapy will be very important as you don’t want to get too stiff.

Brain
I had posted back on September 2016 about my son and his shoulder issues. We tried rehab, but he eventually had surgery on June 1, 2017. He had a posterior labrum repair with debridement requiring 3 anchors and no rotator cuff issues or bicep tendon problems. He is 4 months post app today with full ROM with good internal rotation, his surgeon said he’s right where he needs to be and if he can get more scapula control with therapy in the next 6 weeks he can begin to throw. He’s a freshman RHP on a D1 college scholarship. There’s no decision yet on whether he’ll be redshirted or not. In your opinion what are the odds he will pitch this spring or fully recover his velo?

Tim,

Assuming he begins an interval throwing program in 6 weeks, I would think he could reasonably be throwing bullpens 6-8 weeks after that. I think the likelihood he gets full velocity back should be good given it is not a SLAP tear. As far as pitching this Spring, that is more dependent on how the throwing program progresses and if he has any setbacks.

Thank you Brian, his surgeon has taken precaution and isn’t rushing him which I can appreciate. I will update his status when he begins his throwing program. Thank you again for your input.

I agree with being cautious and base everything on how he feels. Good luck and thanks for the update!

Started throwing program yesterday.

I had reported here before about son’s labrum tear fall 2015 in fall 2017 he was 100% throwing 87 before injury now at 92 two years later and is playing college again so recovery is possible spent time rehabbing and weight training gained 50 lbs and is strong now

Jim,

Thanks for the update and glad to hear about the positive outcome.

My son is at the 90ft mark in his throwing program and is doing well. He is going to be a medical redshirt freshman this spring season. This will give him a full year of recovery. The plan is for him to play collegiate summer ball this summer.

Glad he is doing well. Wishing him a full recovery and good luck this summer!

My son is a catcher and is just turning 15yo. He had SLAP repair with 2 anchors and a they cleaned up a 5% cuff tear. He started the RTP at 7 months and we took it slow. No pain or discomfort during the rehab process or RTP except for suprispinatus tightness during one session. We took three days off and stepped back in the RTP and had no other issues. We are now 10 months post-op and doing well. When should we expect his velo to increase and what can we do to safely improve his velo?

Jeff,

I typically see a maximal medical improvement after these procedures between 12 and 15 months. He may regain his velo before then. I think the key is making sure he stays on an arm care program with strengthening as well as routine posterior shoulder stretching exercises to ensure he does not have any internal impingement issues moving forward.

Hello. My daughter is 12yr old pitcher and recently had a burning, pain in the right shoulder. MRI did not show evidence of tear, but did show a small labrum cyst present. She also has a stage III acromium, with no impingement. She has been in PT for over a month and after being pain free, she now experiences some pain again. She hasn’t thrown for 2 months. Do you think it is the cyst causing the problem? Thanks so much

Joe

Hi Joe,

Paralabral cysts can be common and not necessarily the issue. The type 3 acromion does set up her up for higher risk of rotator cuff impingement/irritation due to the anatomy and hook shape that comes with that.

We are 13 months post opp, just finished his last bullpen this week. His college coach has shut him completely down till July 26th when he will begin his velo program. School will start back Aug 27th and fall practice will begin. He’s done great, shoulder feels good. He’s not throwing full speed , but is still throwing hard. For the last 6 weeks he’s been working with a trainer to strengthen his core to help prevent injuries.

Thanks for the update Tim. Hopefully he continues his way back to 100%. Glad he feels good and pain free after the surgery!