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.


A fall onto an outstretched hand can lead to hand injury, most commonly a wrist or finger fracture.  Hand injury is extraordinarily common in sports.  Other common considerations include wrist sprain, or the subtle and sometimes missed ‘scaphoid fracture’.


Tampa Bay Buccaneers defensive tackle Gerald McCoy is one of the best defensive tackles in the game. In Sunday’s game against the Rams, Gerald McCoy left the game in the second quarter with a hand injury. Team doctor’s quickly diagnosed the injury as a broken hand and declared him out for the rest of the game. He was seen on the sidelines with the hand heavily wrapped and held in position with a sling.

The hand is one of the most intricate and complex structures in the human skeletal system. Including the wrist, the hand consists of 27 bones. These bones include the carpals, metacarpals, and phalanges. The carpals are the bones that make up the wrists. The metacarpals are the bones that make up the palm of the hand. The phalanges are the bones that make up the thumb and fingers. Many of these bones are small and thin and can break quite easily if there is forceful and direct contact to the hand. A broken hand can also occur from an abnormal twisting motion or from the hand being crushed in a fall. If any of these 27 bones are broken then the general diagnosis is a broken hand. However, this diagnosis can be further elaborated by stating both the type of fracture and the bone in which the fracture has occurred.


The symptoms of a broken hand include tenderness, swelling, decreased range of motion of hand or finger, and deformity. A broken hand can put a large amount of burden on the injured because the hands are such an important part of our everyday life. Simple tasks like driving, typing, and writing can become very difficult with a broken hand. However, it is important that you do not continue to utilize this hand to complete these activities if you fear your hand is broken. Visit your family doctor and an osteopathic physician to determine the proper treatment of for your hand.  The doctor will first examine the condition of the skin, the position of the fingers, and the range of motion. The doctor will then schedule an X-ray to identify the location of the fracture and the extent of the fracture.  Contact our award winning sports medicine doctors to evaluate you today.

Once the location and the extent of the fracture are determined, the bones can typically be realigned without surgery. Typically, a splint or brace is used to hold the bone in the proper position to heal. Follow up X-rays are needed to determine that the bone is healing in the proper position. The healing process requires about three to six weeks of proper immobilization. Occasionally, surgery is required to align bones properly. The cases that require surgery are typically the ones where the bone has pierced through the skin. The surgery involves using screws, plates or wires to hold the bones in place. The healing process from surgical repair is usually eight to twelve weeks but can take longer depending on the fracture and the patient.

Gerald McCoy’s broken hand does not require surgery and will be looked at on a week-to-week basis. It is highly unlikely to play this week and is probably questionable for the next week as well, but there is a chance he could return as soon as week 5.


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.

© 2023 Dr. Robert Afra – San Diego Orthopedic Surgery Shoulder – Knee – Elbow