Rotator Cuff Injuries in Baseball and Softball Ron Herman, B.P.H.E., B.Sc.(P.T.)M.C.P.A. Rotator cuff injuries are very common in overhand throwing sports such as baseball and softball. Those of us involved in these sports have most likely either known someone who has suffered one of these injuries or we have suffered one ourselves. At the end of my 1996 slo-pitch season I suffered a rotator cuff injury to my throwing arm and was unable to throw a ball. In the off season I followed a program of physiotherapy exercises and was able to recover 100% by the next season and have yet to have a re-occurrence. The rotator cuff consists of four muscles that attach the arm (humerus) to the shoulder blade (scapula) to form a “ball and socket” type joint. The four muscles (supraspinatus, infraspinatus, subscapularis and teres minor) function to keep this highly mobile joint stable and generate the rotational forces used in throwing. Injuries to the rotator cuff and/or bursae (a fluid filled sac that lubricates the cuff tendons) are very common in throwing sports. They are usually caused by inadequate warm-ups, poor throwing technique, deficient muscular strength and poor posture. As a result, muscle fibers of the cuff can be strained or torn. Pain is usually felt down the shoulder (deltoid area) and can travel down the arm. It is reproduced by lifting the arm above the shoulder level, as is done with throwing. In more serious injuries of the rotator cuff, partial or complete tears of its fibers may result; occasionally, these injuries may require surgery. Treatment of these injuries should begin with an accurate sports medicine diagnosis. Anti-inflammatory medications and physiotherapy form the mainstay of treatment. Physiotherapy focuses on decreasing inflammation initially with ultrasound and other modalities and should progress quickly to appropriate stretching, strengthening, and shoulder stabilization exercises. This will lead into an exercise and warm-up program, which should prevent reoccurrence. Occasionally, cortisone injections may also be needed. Initially, ice is important, so use a bag of crushed ice, ice pack or frozen peas/corn and mold it over the point of the shoulder with a damp face cloth between the ice and your skin for 15 – 20 minutes three to four times a day. Depending on the severity of the injury it may take from 2 weeks to 6 months to recover fully and play at 100 percent. Most importantly, baseball/softball players should practice the steps to prevent a rotator cuff injury. In the off season all we need is a few key stretches and strengthening exercises performed two to three times a week for 15 to 20 minutes. When the season begins, start slow-light throwing progressing with increasing speed and frequency over the next few weeks. Then, through the season, be sure to warm-up with stretching and throws before the games, as well as to continue with your strengthening program at least twice/week. This should lead to a pain-free season. See Also SHOULDER PAIN