That Crazy Pain in My Shoulder!!

Today, a 45 year old baseball pitcher described a pain in his shoulder that only hurt when he crossed his arms and pressed his fist into the back of his arm, pushing his arm forward causing local pain in the front of the shoulder more or less. He also described getting grossly fatigued while pitching, losing both velocity and staying power. The pain came on originally after he pitched through an illness.

Physical exam was insignificant. Rotator cuff screens were negative as was the AC joint screen. Palpation unable to reproduce symptoms. Muscle test negative. Neuro negative. Joint play negative. The only positive symptom occurred with him reproducing the anterior glide of the humeral head on the glenoid using his other hand behind the involved right arm.

My conclusion is that he tore his Glenoid Labrum. We will find out for sure after he has an MRI or surgery if the surgeon decides to go that way.




The Labrum seats around the Gelnoid Fossa to make it effectively deeper for the Humerous to seat properly. When the Labrum tears, it can tear on the top (a SLAP lesion) or on the bottom (a Bankart lesion). You can see the proximity of the biceps lesion to the superior tear in the Labrum, and for this reason, many SLAP lesions actually also involve the Biceps Tendon.



In the event that you actually have a torn Glenoid Labrum in either form, the SLAP lesion or the Bankart tear, I am afraid that the best option is surgical. The good news is that recovery is excellent. The last patient I treated who had surgery for this condition, had both the SLAP and the Bankart lesion, and he went on to a full recovery after surgery by playing college football just a few months later.

Rehab for the post surgical course is not very complex, it just takes hard work. Starting with immobilization, then self mobilization activities, to full ARROM to strengthening to dynamic strengthening and throwing ultimately.

Its a long road back for sure, but the route back to full participation is certain. "Bulletproof" shoulders are possible after surgical repair.