Shoulder injury in a young athlete is usually a result of overuse, barred a distinct traumatic event. One of the types of overuse shoulder injuries that results in severe shoulder pain is called acromial apophysiolysis. Pediatricians often diagnose the condition in young baseball pitchers.

baseball-pitcher-shoulder-injuryIncomplete fusion and tenderness of the acromion is responsible for the shoulder injury, according to the Radiological Society of North America. The acromion forms the bone at the top of the shoulder. It actually consists of four bones that join during a person’s teen years.

In its online journal “Radiology,” the RSNA described the results of a study which found that “young baseball pitchers who throw more than 100 pitches per week are at risk” of suffering acromial apophysiolysis. Some sustain rotator cuff tears and other shoulder injuries, as well.

Another study, also posted at, concluded that acromial apophysiolysis is characterized in part by edema (too much watery fluid accumulating in body cavities or tissues).acromial apophysiolysis shoudler injury

Patients 25 years of age and younger were found to be most susceptible to “superior” shoulder pain  due to the shoulder injury. Researchers confirmed that pitching “is a risk factor (because) it predisposes the patient to the development of an osacromiale and rotator cuff tears after age 25 years.”

The study is titled “Acromial Apophysiolysis: Superior Shoulder Pain and Acromial Nonfusion in the Young Throwing Athlete.” The authors were Johannes B. Roedl, MD, PhD; William B. Morrison, MD; Michael G. Ciccotti, MD; and Adam C. Zoga, MD.

“We kept seeing this injury over and over again in young athletes who come to the hospital at the end of the baseball season with shoulder pain and edema at the acromion, but no other imaging findings,” Roedl, a radiologist, said in a news release. “We believe that, as a result of overuse, edema develops and the acromion bone does not fuse normally.”

The research took place at Thomas Jefferson University Hospital’s Department of Radiology in Philadelphia. It involved 2,372 patients between 15 and 25 years of age who had undergone MRIs to diagnose the cause of their shoulder pain. The imaging tests detected edema of the acromial apophyses in 61 (2.6 percent) of the cases.

“Association of acromial edema with incomplete fusion, pitching and clinical findings was determined in the study group, and in an age- and sex-matched control group,” the researchers wrote.

The patients included men and women, most of whom were baseball pitchers. Roedl said they were chosen for the study because “among high school athletes, pitching is the most common reason for shoulder injury.”

Forty percent of one group of study participants had thrown more than 100 pitches per week, compared with 8 percent in the other group. All the patients were diagnosed with acromial apophysiolysis.

According to, baseball pitchers are not the only athletes at risk. The shoulder injury also happens to those who play softball, tennis, golf, handball, volleyball and other sports that require throwing or hitting an object. Even weight lifters and yoga practitioners are vulnerable.

The best advice for avoiding acromial apophysiolysis and other overuse shoulder injuries is to practice moderation. The shoulder joint needs time to rest and heal. When the arm starts to hurt, it is time to take a break.

The American Academy of Orthopedic Surgeons recommends that pitchers reduce the number of times they throw a ball in a game. The organization supports pitch-count limits set by the USA Baseball Medical Safety Advisory Committee.

Strengthening exercises, and stretching and warming up before workouts, are helpful. Ice and anti-inflammatory medication reduce swelling and discomfort.

If you or your child are faced with unabating shoulder pain, contact our nationally recognized sports medicine physicians at Orthopedic Surgery San Diego.


NFL quarterback, NHL goalie, MLB starting pitcher, and NBA point guard are generally considered the most important positions in the major U.S. sports. A position that is arguably as important is the major league closer. The closer is responsible for whether a team wins close games. A majority of major league games are decided by only 2 runs or less. It is easy to see the importance of a quality closer. Unfortunately for the San Diego Padres, closer Joaquin Benoit has been sidelined off and on by ongoing shoulder pain. He has missed a number of games over the course of the season due to the shoulder pain. Benoit has described a pain fluctuates. That he will feel good for a couple of days but then the inflammation will return. The cause of this pain has not been diagnosed but there are some acute shoulder tears that may be attributing to Benoit’s discomfort.

A SLAP tear is a tear in the top part of the labrum. The labrum is a strong, fibrous tissue that stabilizes the shoulder joint. The labrum acts to deepen the shoulder socket and allows a stronger fit between the upper arm bone, the shoulder blade, and the collarbone. A SLAP tear occurs in both the top-front and top-back portion of the labrum and is often caused by repetitive shoulder motion such as constantly hurling MLB sized curve balls and sliders. When a SLAP tear is present, the patient may experience shoulder pain, decreased strength, decreased range of motion, and unusual and uncomfortable feelings that the shoulder is catching, locking, grinding, or popping out of it’s joint. For major league pitchers there will also likely be a decreased in their pitch velocity.
A partial thickness rotator cuff tear is an incomplete tear of the rotator cuff. The rotator cuff connects the upper arm to the shoulder blade and is essential for shoulder strength and lifting of the arm. A partial tear in the rotator cuff would include damage to the soft tissue of the rotator cuff but would not be severed and would not be disconnected from the upper arm or shoulder blade. When the rotator cuff is torn, a patient will likely experience shoulder pain, shoulder weakness, difficulty lifting and rotating arm, and a crackling sensation in the shoulder. For major league pitchers lifting and rotating the arm is an essential part of the pitching motion. A partial thickness rotator cuff tear can cause tremendous amount of pain and a decrease in pitcher productivity.
For these acute injuries the suggested initial treatment is rest, anti-inflammatory medications, and physical therapy to restore the strength, flexibility, and range of motion. If non-surgical treatment is not sufficient and problems persist or worsen then the next step would be to review surgical options. At this point Joaquin Benoit is experiencing discomfort bad enough to miss some games, but team doctors do not believe that surgery is needed just yet. Time will tell whether he can overcome this nagging shoulder injury or if he will need to have the shoulder repaired via surgery. Call to schedule your appointment with our top notch sports medicine specialists at Orthopedic Surgery San Diego.


Many of the kids playing pop warner or teens playing high school football in the Carlsbad and North County area may have sustained shoulder injuries or neck pain, similar to Pro NFL players.  St. Louis Rams officials described Rodger Saffold’s recent shoulder problem as a “stinger,” a term familiar to people who play contact sports.

Saffold suffered the injury in his left shoulder during training camp, ESPN reported. It took nearly a month for symptoms to subside to the point that the offensive lineman was ready to return to action.  This is unusual.

Technically called a brachial plexus injury, a stinger afflicts about one in two college football players. Wrestlers, gymnasts, snow skiers and martial-arts enthusiasts also are vulnerable. A stinger can occur when a collision or fall causes the shoulder and head to snap in opposite directions. It also may result from the head being forced to the side, or from blunt-force trauma of the collarbone.

Such violent movements and impacts compress and excessively stretch nerves in the neck and shoulder, causing an electric stinging sensation that may extend to the arm and hand. Some patients describe the pain and discomfort as “burning” or “tingling.” Others feel weak or numb in the shoulder or arm. Neck pain can be an indication of another type of injury or disorder.

Many experience the symptoms for only a few seconds or minutes. Others need treatment for several days or weeks. Sometimes, there is a nerve injury that continues to cause shoulder pain and weakness. People who have had one stinger are more likely to suffer more of them. Each time it happens, the joint gets weaker and nerves sustain additional damage.

Nerves function like electrical cables in the spinal canal, allowing the brain to send messages to the muscles. Nerves that branch from the spine, where it meets the neck, form the brachial plexus (a bundle of nerves). All the nerves that permit a person to feel and move the arm travel through the cord.

Most patients get stingers on one side of the body, though full contact with another person or an unmovable object can injure both shoulders. In some cases, people have stingers on both sides because of spinal-cord damage.

Treatments for the pain and burning include resting the shoulder and arm, alternating applications of ice and heat, and taking anti-inflammatory drugs. When the discomfort continues longer than several weeks, medical tests are needed to diagnose the problem. There might be nerve damage that cannot heal on its own.

Doctors study patients’ medical histories, and conduct physical exams, to diagnose stingers. They determine the extent to which the brachial plexus has been stretched, and evaluate nerve function and reflexes. More tests are ordered if a patient appears to have a cervical spine injury. Diagnostic methods include x-rays, MRIs and EMGs.  It is important the player seek medical attention so that a doctor can unmask any latent anatomic risks that puts a player at risk.

Some patients wear cervical collars to take pressure off the nerves until they can recover. Doctors often give cortisone to reduce the swelling. They advise patients to refrain from strenuous activity until the pain is gone, full range of neck motion returns, and testing has confirmed there is no nerve damage. Strengthening neck muscles and improving posture can help prevent recurrences.

Surgery becomes necessary when a herniated disk or bone spur compresses and injures a nerve. Without the procedure, a patient is likely to continue experiencing severe pain and weakness.  Let our Orthopedic Surgery San Diego award winning orthopedic sports medicine specialists evaluate you to help you maximize your recovery.


Shoulder pain.  It can plague us all, even the great ones!  There is very little debate over who the NFL’s greatest wide receiver of all time is. Jerry Rice is the best there ever was. But did you know that Jerry’s football DNA has been passed on to a son, Jerry Rice Jr.? That is correct. He is an incoming rookie wide receiver.  With some experience at my old alma mater, UCLA.   He was set to potentially follow in his father’s footsteps until an unfortunate injury. Jerry Rice Jr. suffered a significant shoulder injury when he landed awkwardly on it during practice. The diagnosis: a labrum tear.

The labrum is a fibrous cartilage that is located in the shoulder joint. The shoulder joint is one of the most common examples of a ball and socket joint. This joint is where the shoulder blade cavity (glenoid cavity) and upper arm bone (humerus) meet and form the respective ball and socket. The labrum acts as a joint stabilizer that both deepens the socket and sucks the humerus into the socket.

If the labrum tears, the shoulder can become unstable. Labrum tear causes decreased range of motion, decreased strength, and pain. In addition, severe labrum tears tend to cause abnormal shoulder joint interactions such as grinding, locking, popping, and catching. While these interactions sound like a set of trendy new dance moves, they can be painful and quite discomforting.

There are a number of different types of labrum tear; the main types are SLAP tears and bankart tears, but these also has a set of sub-categorizations based on the severity of the tear. A SLAP (Superior Labrum Anterior and Posterior) tear involves the top of the shoulder and essentially involves the disconnection of the labrum from its ball and socket attachment points. A SLAP tear is usually diagnosed in terms of severities from type 1 to type 4. Type 1 is a partial tear where the edges of the labrum fray but do not become completely detached. Type 2 is the most common and does involve a complete detachment of the upper labrum from the socket. Type 3 is where the tear from the socket causes the labrum to actually folds over itself between the ball and socket. Type 4 is where the tear actually extends to the bicep tendon. The bankart tear involves the front of the shoulder. The reverse bankart tear involves the back of the shoulder.

Treatment can involve anything from rest followed by rehabilitation to arthroscopic surgery.  In the case of type 1 SLAP labrum tears the typical treatment would just be rest, anti-inflammatory medications, and rehabilitation if needed. Most large tears will require surgery, which will involves trimming, repair or reattachment. After successful surgery, recovery time involves using a sling for approximately a month followed by anywhere from a month to three months of rehabilitation to regain complete strength and range of motion.

In the case of Jerry Rice Jr., his torn labrum did require surgery and it is considered season ending. But if he has half of the heart that his father had, you can bet that Jerry Rice Jr. will have a bright future in the NFL.


Shoulder Pain and knee discomfort plague tons of active ‘regular Joes and Joannes’.  Pain relief is an evergreen topic in the field of orthopedic medicine. Most patients come to my practice only when the pain reaches a fever pitch, and by then it is often too acute to treat with ‘the more gentler’ methods.

But there are a number of good ways you can relieve chronic pain before it reaches the boiling point, including herbs, changes of diet, and exercise. Stretching remains the simplest of all and the most portable, which is why I am always on the lookout for easy stretches to help my patients on the go.

This article includes some of the easiest I have seen, including one easy variation on a knee bend:

1. Stand with feet wider than hip-width. Deeply bend both knees and shift your hips back. Place hands on your thighs with fingers pointed inward.
2. Drop right shoulder to the midline of your body pressing into your thigh for leverage. Come back to center and drop left shoulder to the midline of your body. Maintain a strong core and keep glutes engaged the entire time for additional support.
3. Continue to alternate for 30 seconds to one minute.

For more great tips and expert medical care, contact San Diego’s orthopedic surgery experts today.


One of the interesting parts about working in sports medicine is that my field literally appears on the sports page on a regular basis. Athletes undergo surgery often because their work involves frequent exertion, extension and – for certain sports – hard collisions. And fans rarely hesitate to weigh in about the relative wisdom and prognosis of a given procedure.

The truth is often far less complex than fans and team owners would imagine: when orthopedic surgery is indicated, it simply must be done. Scar tissue and lingering injuries typically don’t heal on their own, especially when a patient is required by his or her job to keep doing whatever caused the injury in the first place. Case in point: the outcry over Mark Sanchez’s recent announcement that he’s undergone season-ending shoulder surgery.

Absent any intimate knowledge of the case, I can say that it’s likely Sanchez’s shoulder pain did not respond to soft tissue techniques or steroids. So what’s next? Shoulder surgery is the most effective way to rebuild structures that have been injured, and to restore a full and pain-free range of motion. The upside far outweighs the downside in this case: Sanchez’s season is over, but his career may well have been saved.

As an experienced orthopedic surgeon here in San Diego, I see a great number of athletes and active people. Surgery is rarely a first strategy, but under the right circumstances it often represents the surest way to repair tears, tendinitis and instability. If you’re suffering from ongoing shoulder pain and want to review all the best options, I urge you to contact my orthopedic surgery offices here today.


Orthopedic surgery and sports medicine are demanding disciplines, highlighted by a constant stream of innovative medical technologies. As an experienced orthopedic surgeon here in San Diego, I field a lot of questions from my patients about how to treat sports injuries and musculoskeletal pain. Although I make time to answer questions in person, I have often wished I had a space where I could explore some of these questions in a bit more depth. This blog is that space – a place designed to discover and discuss what’s new, what’s next and what’s best in the field of orthopedic medicine. A brief word about me: I am the former Chief of Sports Medicine at the University of California, San Diego. I have completed fellowships and training at Boston University, Hawaii’s Queen Emma Medical Center, and the world famous O’Brien Microsurgical Institute in Melbourne, Australia. Earlier in my career, I studied at UCLA and conducted research at the Salk Institute on an NIH research stipend. As you look around this site, you’ll see that I offer a wide array of services, including cutting edge procedures in shoulder surgery, knee surgery and hand and elbow surgery. If you are experiencing lasting discomfort and want to consult with the finest team in Southern California, I invite you to visit my orthopedic surgery offices here today. In the meantime: please bookmark this site and check back often! We have lots of fascinating medical studies, news, ideas and developments ahead. Welcome aboard.

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