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Baseball Shoulder Injuries: Causes, Symptoms, and Treatment Options
Date posted: 5/7/2025
Last updated: 5/7/2025
Whether you’re a Little Leaguer or a Major League pitcher, the demands of baseball place intense stress on the shoulder, especially with repetitive throwing motions. Shoulder pain in baseball players is not just common; it’s often an early warning sign of a more serious injury. As an orthopaedic surgeon and head team physician for the Chicago White Sox, I’ve spent over two decades helping athletes recover from — and prevent — these injuries. In this article, I’ll break down the most common shoulder injuries in baseball, how we diagnose and treat them, and what players, coaches, and parents can do to keep throwing arms healthy.
Why Baseball Players Are Prone to Shoulder Injuries
Throwing a baseball, particularly at high velocity, is one of the most unnatural and high-stress motions the human body can perform. A pitch can generate rotational velocities of over 7,000 degrees per second in the shoulder joint. This level of torque, repeated over hundreds of pitches in a season, can wear down even the most conditioned athletes.
Key risk factors include:
- Repetitive overhead throwing
- Year-round competition without proper rest
- Poor throwing mechanics
- Muscle imbalances or weakness in the rotator cuff and scapular stabilizers
- Early sports specialization in youth athletes
- Inadequate lower body/CORE strength and conditioning
Common Shoulder Injuries in Baseball Players
1. Rotator Cuff Tendinitis and Tears
The rotator cuff consists of four muscles and their tendons that help stabilize and move the shoulder. Over time, repetitive stress can cause microtears or inflammation. In younger athletes, this usually presents as tendinitis, but older or high-volume throwers may suffer partial or full-thickness tears.
Symptoms:
- Dull ache deep in the shoulder
- Pain during or after throwing
- Decreased throwing velocity or control
- Night pain or difficulty sleeping on the affected side
- Weakness during workouts or with strength testing
2. SLAP Tear (Superior Labrum Anterior to Posterior)
The labrum is a ring of cartilage that helps deepen the shoulder socket. A SLAP tear occurs when this cartilage is torn at the top of the socket, often due to excessive external rotation and traction on the biceps tendon during the late cocking phase of a pitch.
Symptoms:
- Popping or clicking in the shoulder
- Pain deep within the joint, often on the back of the shoulder
- Pain during the Cocking phase of throwing
- Loss of power or accuracy; Reduced velocity
- Sensation of instability when throwing
SLAP tears are notoriously difficult to diagnose and may not always appear clearly on MRI without contrast. Treatment generally involves rest, rehab and often injections. In some cases, shoulder arthroscopy is required to confirm the diagnosis.
3. Internal Impingement
Internal impingement occurs when the rotator cuff becomes pinched between the humeral head and the glenoid during the late cocking phase of a throw. This condition is commonly seen in overhead athletes and can cause progressive damage if not addressed.
Symptoms:
- Posterior shoulder pain during late cocking
- Decreased range of motion (especially internal rotation)
- Weakness or tightness in the posterior capsule
4. Shoulder Instability
Over time, microtrauma from repetitive motion can stretch the ligaments around the shoulder joint, leading to instability. Players may feel like the shoulder is "loose" or prone to slipping.
Symptoms:
- Shoulder “slipping” or “popping out”
- Fatigue or discomfort during games
- Subtle decline in performance
In younger athletes, this can sometimes progress to a full dislocation or labral tear if not treated. Treatment options include rest, therapy to make sure motion is maintained, strength is adequate and scapular motion is normalized. Oral anti-inflammatory medication or injections can be used for pain control and to better facilitate rehabilitation. In some cases, when conservative management fails. Surgical arthroscopy of the shoulder is required.
Diagnosis: What to Expect at a Sports Medicine Clinic
At Midwest Orthopaedics at Rush, we begin with a comprehensive evaluation that includes:
- Detailed history of symptoms and performance changes
- Physical exam testing range of motion, strength, and stability
- Advanced imaging (MRI with arthrogram, ultrasound, or X-rays)
- Treatment recommendations and plan for return to play
- Optional diagnostic motion analysis for high-level athletes
Our goal is to pinpoint the exact structure involved and customize a treatment plan based on your position, level of play, and career goals.
Non-Surgical Treatment Options
Most throwing-related shoulder injuries in baseball players can be treated conservatively, especially when caught early. These approaches may include:
- Physical therapy: Emphasizing rotator cuff and scapular stabilization, posterior capsule stretching, and correcting mechanical flaws
- Rest and pitch count reduction: A minimum of 6–8 weeks of rest is often needed, depending on injury severity
- Anti-inflammatory medications: NSAIDs can help manage pain and swelling in the short term
- Injections: Corticosteroid or platelet-rich plasma (PRP) injections may be helpful in select cases
Rehabilitation is progressive and position-specific. For pitchers, return-to-throw programs are carefully monitored over weeks to months with objective benchmarks.
When Surgery Is Necessary
- Surgery is typically reserved for:
- Significant Partial or Full-thickness Rotator Cuff Tears
- Labral tears not responding to rehab
- Recurrent shoulder instability
- High-level athletes whose performance is significantly limited
Modern arthroscopic techniques allow for smaller incisions, quicker recovery, and a high return-to-sport rate. At Midwest Orthopaedics at Rush, we have one of the highest volumes of shoulder surgeries for overhead athletes in the country, with outcomes that meet or exceed national benchmarks.
Prevention: The Real Game-Changer
An ounce of prevention is worth more than innings lost to injury. Prevention strategies should begin at the youth level and continue through professional play.
Key prevention tips:
- Follow pitch count guidelines recommended by Little League and USA Baseball
- Take at least 2–4 months off from throwing each year
- Avoid early specialization in baseball for athletes under 14
- Prioritize strength and mobility in the rotator cuff, core, and hips
- Implement a pre-throwing warmup routine
- Get regular evaluations from qualified sports medicine professionals
Enhance Recovery and Prevent Future Injuries
At Midwest Orthopaedics at Rush, we don’t just treat injuries—we help athletes recover smarter and return stronger. Through our comprehensive Sports Performance and Recovery services, athletes of all levels can benefit from advanced biomechanical assessments, personalized strength and conditioning programs, and recovery techniques backed by sports science.
Whether you’re recovering from a throwing injury or looking to prevent the next one, our expert team can evaluate your movement patterns, identify risk areas, and design a custom plan to optimize performance and longevity in your sport.
Take the First Step Toward Shoulder Recovery
Shoulder pain doesn’t just affect your game — it can affect your future. Whether you're a high school player, a collegiate athlete, or a pro, we’re here to help you recover and return stronger than ever.
At Midwest Orthopaedics at Rush, our team combines expert-level care, cutting-edge research, and a deep understanding of the demands of throwing sports. Let’s get you back in the game — the right way.
Schedule an appointment with Dr. Nikhil Verma or a member of our Sports Medicine team today.
