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Doctors Helping Pitchers Shoulder Load

Grant funding study to determine how injuries occurr, find ways to prevent injuries and how to rehabilitate them once they occur

  • Date: 5/13/2011
  • BIDMC Contact: Gary Gillis

Austin, who was "rebuilt" after a fiery training crash. Austin received a bionic eye with a 20:1 zoom and infrared, two bionic legs that topped out at about 60 mph and a bionic right arm that could uncork an unhittable fastball if given the chance. The operation cost us taxpayers $6 million, but he was one of a kind.

Nowadays, you can find $6 million men everywhere you look -- especially if you look on Major League rosters. More than 150 ballplayers make at least $6 million per year. Sixty-seven of those guys are pitchers. And since there are no bionic arms available just yet, preventing injury and protecting their investment is something that ballclubs are quite interested in doing.

All of the above is a long way of getting around to saying that the grant that Major League Baseball awarded three years ago to Dr. Arun Ramappa, chief of  Sports Medicine & Shoulder Surgery in the  Carl J. Shapiro Department of Orthopaedic Surgery at Beth Israel Deaconess Medical Center, is already paying dividends.

Former Red Sox starter Curt Schilling is one of many pitchers who have needed shoulder surgery. (Kathy Wilens/AP)

"We were looking to gain a better understanding of the mechanics of pitching and the stresses that it creates in the shoulder joint," explained Dr. Ramappa. "Specifically, we recreated those mechanics in an effort to determine how injuries occurred. Our goal is to find ways to prevent these injuries and how to rehabilitate them once they occur."

Dr. Ramappa and colleagues at the Center for Advanced Orthopedic Studies at Beth Israel Deaconess Medical Center designed and constructed a complex apparatus that allowed them to manipulate cadaver arms and study them in various positions and under various stresses.

"High-speed cameras were used to capture the motion of Major League pitchers," Dr. Ramappa said. "We used this data to program a computer that would direct our device to replicate their pitching motion, though at a lot slower speed. One of the issues that was implicated in a number of shoulder problems was misalignment of the scapula -- your shoulder blade."

The shoulder joint is at the top of the list when it comes to range of motion. That range of motion is achieved by a unique structure of bones, muscles, tendons and ligaments that gets pushed to the limit by pitching. A misalignment is often an injury waiting to happen.

"We were able to create misalignment in our shoulders and observe the effect it had," explained Dr. Ramappa. "It increased stress on the shoulder joint and the stress can often cause impingement of the rotator cuff -- the name for the group of muscles which connects the shoulder blade and the upper arm,"

An impingement of the rotator cuff is bad news for a pitcher. It's likely to affect his velocity and his ability to throw certain pitches, not to mention causing him some degree of pain.

"In some respects, it's not surprising that a pitcher's shoulder blade might get misaligned," said Dr. Ramappa. "Since this misalignment often occurs in non-athletes, athletes that consistently use their shoulder may be at additional risk. The insights we gained have implications not just for professional athletes, but for many common shoulder problems that you and I might have as well."

Shoulder problems can be an occupational hazard for carpenters, painters, recreational tennis players or, in my case, a Springer Spaniel owner. When my shoulder became so painful and weak that I was unable to play fetch with the dog, I made an appointment with Dr. Ramappa, convinced I was going to go under the knife. Instead, the remedy was physical therapy. My Spring Training consisted of daily sessions with elastic Thera-Bands and light weights.

"There's more studying to be done, but if relatively simple steps can be taken to preserve a pitcher's health and livelihood -- that's a real bonus," said Dr. Ramappa. "And if we can keep you out of surgery and on your job, there's a real benefit in time, money and prevention of future injury. We keep everyone happy."

Absolutely true in my case -- and I think I can speak for the dog, too.

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor. Beth Israel Deaconess Medical Center is the Official Hospital of the Boston Red Sox.