He injured 3 weeks ago. Pain away from actual rotator area looks to be tricep lateral tendon area per PT. Originally had actual movement pain up to day 4. Rested for 2 weeks started throwing fine but has some pain when he gives above 80% effort pitching. Pain doesn’t linger just when he throws. Thoughts, just a little more healing and rest or sign of some thing else? Can not recreate pain with arm motions, lifting, etc… Additional stretches exercises?
Pain away from actual rotator area looks to be triceps lateral tendon area per PT.
This is virtually a strange injury unless he is throwing correctly, In which case it would be a fitness injury! In that you should use your triceps to extend your Elbow concentrically but it has repeatedly been proven with EMG studies on the traditional Pectorallis major (Horizontal Humerus) driven pitches or throws that the Triceps never fire off because the Biceps are contracting eccentrically (contracting while lengthening) to control the coming hyper extension of the Elbow, that it fails in doing so. This is a major break in the kinetic chain of throwers.
This is by far the worst area to diagnose!!! All 4 rotator cuff muscle tendons attach in a circle around the Triceps tendon. Plus there is 2 major muscle attachments (lats /Pec) near by. The proximal Humeral growth plate is under all of that.?
“Originally had actual movement pain up to day 4.”
The Tendon is big and well attached, most of these are grade tears of the muscle, his is sounding grade 2 ish ? You will know by the time it takes to heal. Tendons take 1 to 3 months to heal with simple pulls. Muscle is quick and even quicker with light daily stimulation 1 week to 3 weeks for low grade pulls.
“Rested for 2 weeks started throwing fine but has some pain when he gives above 80% effort pitching.”
He should not be pitching!! at all. He should be lightly drilling minimal backwards chained ball low impact throws for specific blood feed. Rest = atrophy in low grade pulls.
The Triceps is the fastest muscle in the upper body and it is heavily neglected by throwing athletes because it is not used by most. Watch how javelin throwers outwardly rotate their Humerus while still maintaining length, this allows them the ability to actually extend their Elbows with concentric voluntary Triceps drive with a vertical Elbow where the lat’s are primary mover from the best possible length.
I hope your PT’s diagnosis is correct, old video would help pin point his use.
“Can not recreate pain with arm motions”
This means if you tried to diagnose it now, you couldn’t! This is a good sign he’s healing fast
Hope your PT has him on a low impact latex resistance routine like the one Steven Ellis has here.
“ lifting, etc… Additional stretches exercises?”
Stay away from Static stretching that was all the craze 40 years ago and persists in many forced creative applications that actually cause laxity and instability at the shoulders and Elbow.
Learn actual “sport specific “ resistance exercises. Not talking general balanced fitness here!