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November 2, 2019

Pain on the Diamond: Ten Common Baseball Injuries

November 2, 2019


When most people think of sports injuries, they immediately picture football players taking rough hits, but baseball players are not immune to injury. Professional baseball players often play every day for months at a time. This puts a lot of wear and tear on their bodies, and the constant stress takes its toll. The ten injuries below are some of the most common injuries suffered by professional baseball players, and each is responsible for sending many critical players to the disabled list.

1. Rotator Cuff Tear

The rotator cuff is made up of muscles and tendons that stabilize the shoulder joint. The throwing motion puts a lot of stress on these structures, and over the course of a career, damage to the rotator cuff can become significant. Factors like age, insufficient or hurried warm ups and improper conditioning in the off season make the situation worse.

Due to constant use, rotator cuff tendons fray over time, and small tears occur. The more damaged the rotator cuff becomes, the more pain the affected player experiences and the more likely he is to suffer a major injury to the area. After a significant tear, the player loses his ability to rotate his shoulder properly and finds throwing painful. Rotator cuff tears are most common in pitchers, but they do occur in position players as well.

A torn rotator cuff is usually a season-ending injury, and it has the potential to become a career-ending injury. While many tears can be repaired with same-day surgical techniques or simply through rest and physical therapy, healing of the rotator cuff is often slow. Even with the best care, some players will experience a permanent decrease in ability.

Many pitchers successfully return to pitching after treatment for partial rotator cuff tears, but it is more difficult for a pitcher to successfully return to the major leagues after suffering a complete tear. One example of a pitcher who did return after a complete tear is All-Star Pedro Martinez. In 2006, Martinez was diagnosed with both a full-thickness rotator cuff tear in his pitching shoulder and a calf injury. He underwent surgery and spent most of the 2007 season rehabilitating his injured shoulder and leg.

Martinez returned to pitch successfully for the New York Mets at the end of the 2007 season, but he was injured again early in the 2008 season. Late in the 2009 season, he joined the Philadelphia Phillies, and he pitched effectively in the playoffs and the World Series.

2. Torn Labrum

The labrum is the cuff of cartilage that surrounds the shallow socket of the shoulder joint. Its job is to hold the bones in place and provide stability. The pitching motion puts tremendous stress on the labrum, and over time, the cartilage frays and tears. Labral tears range from mild micro tears to large tears involving other shoulder structures.

Pitchers with minor labral damage might not experience significant symptoms, but with more severe tears, symptoms can include shoulder pain, swelling, loss of throwing velocity and a feeling of instability in the shoulder. Diagnosis can be difficult as not all labral tears are easily visible on an MRI.

Minor labral damage can be treated with rest and anti-inflammatories, but significant tears require surgical repair. Recovery time depends on the type and location of the tear. Pitchers with injuries that involve other parts of the shoulder, including the rotator cuff, bursa, biceps tendons and others, have a lower chance of making a full recovery than those with uncomplicated tears.

While there are many pitchers who never returned to the majors after surgery for a torn labrum, success stories do exist. On example is Chris Carpenter. In 2002, he underwent surgery to repair his labrum and missed the entire 2003 season. When he returned to the majors in 2004, he had a successful season with the Saint Louis Cardinals, and in 2005, he pitched 241 2/3 innings and won the National League Cy Young Award.

3. Ulnar Collateral Ligament (UCL) Injury

The UCL provides stability to the inner part of the elbow. The throwing motion puts a lot of stress on this ligament and can cause it to tear. Most commonly, UCL tears occur over time as the ligament weakens due to repetitive stress. Usually, symptoms of a UCL tear include elbow pain that worsens over time, a lack of control when throwing and a loss of throwing velocity. In some cases, symptoms can be traced back to one throw during which the player felt a popping sensation or sudden pain in the elbow.

UCL tears are diagnosed based on physical examination and the results of imaging studies. Major tears require surgical repair, and surgery is often also the best option for less severe tears. This is because the rest required to heal even minor tears can be significant, and the injury is often a nagging one.

UCL reconstruction, commonly called Tommy John surgery, is probably familiar to most baseball fans. Made famous by Tommy John, the pitcher who underwent the procedure in 1974, UCL reconstruction involves replacing the damaged UCL with another ligament harvested from the patient himself or from a cadaver.

Since 1974, the UCL reconstruction procedure has been refined. New surgical techniques are less traumatic and have higher success rates than the original procedure. Typically, it takes a pitcher about a year to return to form after this surgery, and a position player could potentially return to the majors six months after Tommy John surgery.

After his surgery, Tommy John missed the 1975 season and returned in 1976. He went on to win over 160 games after his return and continued to pitch until his retirement in 1989. Since the time John underwent the surgery, many other players, including such notables as Josh Johnson, John Smoltz, Billy Wagner, David Wells, Tim Hudson and Chris Carpenter, have made successful comebacks following the procedure. Even Mariano Rivera, widely considered the greatest closer of all time, underwent surgery to repair his UCL in 1992. His injury did not, however, require UCL replacement.

4. Elbow Inflammation

Due to the stress that throwing places on the elbow joint, baseball players, especially pitchers, are susceptible to both pitcher's elbow and tennis elbow. Pitcher's elbow, more properly termed medial epicondylitis, is caused by chronic damage to the tendons that move the wrist toward the palm. This results in pain along the inside of the elbow and forearm. Tennis elbow, also known as lateral epicondylitis, is an overuse injury caused by constant flexion and extension of the forearm. It results in pain on the outside of the elbow, forearm and wrist. Both lateral and medial epicondylitis can cause weakness in the hand and wrist.

Treatment for lateral and medial epicondylitis involves rest and the use of medications to reduce inflammation. For more severe cases, steroid injections are often be helpful. If rest and medications fail to resolve the problem, certain surgical procedures can provide relief and allow the player to return to full function.

Elbow inflammation is a common reason for players, especially pitchers, to miss starts or spend time on the disabled list. For example, in 2013, the St. Louis Cardinals placed starting pitcher Jake Westbrook on the 15-day disabled list due to right elbow inflammation.

5. Hand and Wrist Injuries

Players frequently suffer hand or wrist damage due to collisions with pitched balls, the ground, bats and other players. These accidents can result in fractures, dislocations, sprains, bruises and other injuries. Treatment for hand and wrist injuries can be as simple as taping fingers together or icing a swollen finger or as extreme as surgery.

Recently, there has been an increase in the incidence of hamate bone fractures among hitters. The hamate bone is a small bone located on the same side of the wrist as the little finger. The bone, which fractures relatively easily when hit with a bat, is important for maintaining control while hitting and throwing. Symptoms of a fractured hamate include pain, swelling and difficulty swinging a bat or throwing a ball. Treatment requires immobilization of the wrist and rest. If the injury has gone untreated for any length of time, however, surgical correction may be necessary. Typically, players with hamate fractures require three to six weeks of recovery time before they are fit to play.

During the 2010 season, Troy Tulowitzki missed nearly six weeks after fracturing his hamate bone. After his return, the Colorado Rockies shortstop hit 18 home runs and had 61 RBIs. Other players who have suffered hamate bone fractures include Pablo Sandoval, Domonic Brown, Jose Canseco, Ken Griffey, Jr., Tony Gwynn, Jr., Dustin Pedroia and Jim Thome.

6. Torn Meniscus

Each knee contains two cushions of cartilage that keep the femur and tibia from grinding against one another and help the knee joint to move smoothly. These are called menisci, and they often tear due to hyper-flexion or twisting of the knee. These tears frequently occur when players are pivoting to throw, running the bases, running to catch fly balls or sliding.

When one of his menisci tears, a player typically experiences a popping sensation. At first, he may feel no pain and may be able to continue playing for a time. Later, symptoms of inflammation, including pain, set in, and the knee may swell and begin to feel tight or unstable. The pain is usually most severe when the player tries to rotate his injured knee. In addition, the player will often feel as if he knee is locking, and he may find straightening the knee to be difficult or painful.

Diagnosis of a torn meniscus is usually based on physical examination and MRI studies. To correct the injury, most players require arthroscopic surgery followed by rest and rehabilitation. Some players choose to continue playing with minor meniscus tears until symptoms make surgery necessary.

One example of a player who chose to delay surgery is Chipper Jones. In May, 2011, the Atlanta Braves third baseman was diagnosed with a minor meniscus tear. He elected to play with the injury until July, 2011 when he had arthroscopic surgery on his knee. He missed two weeks for surgery and rehabilitation and finished the season with a total of 126 games.

7. Torn Anterior Cruciate Ligament (ACL)

Although they occur more commonly in football, basketball and soccer players, ACL injuries do occur in baseball players. The ACL is the fibrous band that connects the femur to the tibia to stabilize the knee. Typically, ACL tears in baseball happen as a result of a player stopping suddenly or pivoting. Often, the affected player feels a popping sensation when his tendon rips. Other symptoms include pain, swelling and instability of the knee. Diagnosis of an ACL tear is usually based on physical examination and MRI results.

While many ordinary people recover from this injury without surgery, most professional players require surgery for ACL tears. The specific technique used to reconstruct the ACL depends on the injury, the surgeon performing the procedure and the player's preference. Players typically need six months to a year of recovery time after ACL reconstruction.

In May, 2008, starting pitcher Yovani Gallardo of the Milwaukee Brewers tore his ACL. Gallardo, who was 22 years old at the time of the injury, underwent surgery and made a rapid recovery. He was back on the mound in late September of the same year. Other players who have suffered ACL tears include Alex Gonzalez, Mariano Rivera, Chipper Jones, Mat Gamel, Scott Sizemore, Wilson Ramos and Victor Martinez.


8. Head Injuries

Concussions and other traumatic head injuries in baseball players usually occur due to players colliding with one another or being hit with a ball. A player does not even need to be hit on the head to suffer a concussion. Any injury that jars the brain can cause a this type of injury.

Symptoms of a concussion may begin immediately after injury or not become apparent until hours or days later. Typical symptoms include balance issues, dizziness, confusion, disorientation, loss of memory, headaches, difficulty concentrating, sleep disturbances and nausea. Additional symptoms or more severe symptoms can indicate a more dangerous brain injury.

Currently, Major League Baseball requires teams to follow a certain protocol with players who are suspected of having concussions. This protocol includes a 7-day disabled list for players with concussions, procedures for evaluating players suspected of having brain injuries and tests concussed players must pass before being cleared to return to play.

In September, 2011, Chase Utley suffered a mild concussion after being hit in the head with a pitch. After a few days, the Phillies All-Star second basemen was free of obvious symptoms. He was cleared to return to the game after passing required neuropsychological tests one week after his injury. Utley's concussion was mild. Other players, including J.A. Happ, Jason Bay and Justin Morneau, have suffered more serious head injuries, and these have required much longer absences.

9. Muscle Strains

A strain is an injury to a muscle or a tendon due to overstretching. Commonly strained muscles among baseball players include the hamstrings, quadriceps, calves, back and abdominals. Strains vary in their severity, but these injuries are extremely common.

Treatment for strains typically involves rest, physical therapy and anti-inflammatory medications. For severe muscle tears, surgery may be required. Recovery time is quite variable. Minor strains may require little recovery time while severe injuries require more time. Strains are also likely to linger or recur if recovery is rushed or initial treatment is inadequate.

Examples of strains in professional players are numerous, but one recent case involves Shane Victorino, an outfielder for the Boston Red Sox. In April of 2013, Victorino suffered a lower back strain that hampered his ability to play and caused him to miss seven games. After resting his back for a little over a week, he returned and hit for a higher average in the ten games following his injury than in the games he played before the injury.

10.  Ankle Sprains

When the ankle rolls or twists beyond its normal range of motion, the ligaments that stabilize the joint stretch or tear. This is referred to as an ankle sprain, and it is a common injury among runners and fielders.

Ankle sprains range in severity from mild to severe. Mild sprains produce minimal pain and swelling. They require little treatment beyond rest and stretching and strengthening exercises. Moderate sprains cause more intense ankle tenderness and swelling as well as instability and a decreased range of motion. These often require four to six weeks of rest and physical therapy to heal. Severe sprains involve complete ligament rupture and produce significant pain, inability to bear weight and joint instability. These sprains typically require eight to 12 weeks of recovery time. If the initial sprain is very severe, initial treatment is insufficient or recovery is rushed, ankle sprains can turn into chronic problems, and surgical correction may become necessary.

In April, 2013, Jose Reyes, shortstop for the Toronto Blue Jays, suffered a severe left ankle sprain while sliding into second base. After an MRI, doctors decided that Reyes' injury did not require surgery but that he would need to miss at least three months of playing time while his ankle healed. Other players who have suffered ankle sprains include Juan Francisco, Brett Anderson, Josh Beckett, Johan Santana, Jed Lowrie and many others.

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