Shoulder Impingement Sydrome in 15-year-old Pitcher

Post 2006 season, my 15-year-old son, a rep-level pitcher, started complaining about shoulder pain and popping. He and I went to the U.of Toronto Sports Medicine Clinic where he was diagnosed with Shoulder Impingement Syndrome after undergoing MRI examination as well. The doctor there seemed concerned to the extent that he implied that his pitching career may be in jeopardy. Part of the reason for the extra concern is that that there is evidence of bone loss and also a couple of cysts, very unusual in one so young. The doctor believes the problem stems from something being done incorrectly in his mechanics (arm moving back without shoulder accompaniment (but he doesn’t “short arm”!)?) and that if this isn’t found and corrected, the outlook is grim. It’s a bit frustrating since my son appears to have very good mechanics. My son (and yes, me too) is semi devastated at the prospect of not pitching. He will of course follow the suggested physio-therapy and we are seeing an ortho surgeon for a second opinion. I’d be very grateful for any opinions on treatment or prognosis from those with experience or knowledge (especially encouraging ones! :>))…thanks all!

Richard K.

Do you have any video of your son throwing? That’s the only way to definitively identify the root cause of the problem.

If you don’t have any video, then what professional pitcher would you compare your son to?

Where exactly are the problems occurring? What muscles? What bony structures?

If I had to guess, I’d say that the problem is either…

  1. His taking his Pitching Arm Side (aka PAS) elbow above and behind his shoulders (ala Mark Prior).

  2. Rotating his shoulders before his PAS forearm is vertical.

I won’t guess.
First get him better. If it means missing all or part of a season, imagine how devestating it will be for the both of you if you don’t wait and he’s done before the passion is gone? I suspect that unless you have intrusive treatment he will be doing physical therapy, be religious about it and ensure you have open communication with him…Don’t let him lie about no pain and start throwing before he’s ready. In the mean time work on what conditioning (Running…etc.) you can let him do. When he’s cleared medically and by himself (He has to feel confident that he can pitch with no pain). Start slow and build, I would take him to a reputable instructor, have him assessed (I’d try to make sure he’s filmed) as to his mechanics at that point, if he has a flaw that caused that sort of issue believe it or not it will show quickly… Remember that you are at an age where if he does want to play at the next level you cannot monkey around. Devise a plan, get advice from the doctors and his coaches, if he doesn’t progress look to where you can adjust your plan and keep moving, time is always hanging over your shoulder.
I can offer you optimism and my prayers, but few things aid morale more than taking charge of your destiny in a confident positive manner. Let him know it’s a haul and it will challenge his will but you guys can get through this together. Let your love work for you, even though sometimes it means being tough. Be a leader not a hand wringer. It will pay off in the long run even if (And I mean God forbid!!) he’s done because he will understand about setting a goal and working for it and know how much the old man really cares about his future.
Good Luck! I really will have you in my prayers.

Nobody can diagnose something like this over the internet. I do know of one case where a pitcher had an impingement who threw sidearm. Although one might jump on that as the problem it actually turned out that throwing sidearm was an adaptation that put off the damaging effects of the impingement for quite a while.

Sometimes people consider throwing excessively overhand to be good mechanics, and throwing too overhand can lead to impingement problems.

Neither I nor anyone else can diagnose his problem over the internet. You want to find the best pitching coach you can in your area to assess his mechanics. You might even want to go to more than one pitching coach just to get differing opinions and then go back to the doctor with those opinions.

Many thanks for the replies. Chris, I do have a lowish quality video of him throwing which I will try to digitize but at the very least take to the doctors. His style to me seems very similar to that of Roy Oswalt. Once I see the Ortho doctor, I will know more about which bones and muscles are impinging.
dfromfla, I am very grateful for both your advice and empathy; it means a lot to us.
CADad, your advice will also be incorporated. Thanks all!


One thing to look for is the height of his Pitching Arm Side elbow relative to the level of his shoulders.

[quote=“Chris O’Leary”]One thing to look for is the height of his Pitching Arm Side elbow relative to the level of his shoulders.[/quote]I see you’re still at it with this. At what point? You know where I’m going with this.

Richard K.,

I’ve got no argument with the recommendations to have your son’s mechanics looked at by a pitching instructor. My only concern is that there are lots of pitching instructors who are too set in their ways and only know how to teach what fits their view of things. If your son is serious about continuing to play and advancing to the next level, then once your son has been healed and ok’d to start throw you might want to check into taking him to be seen by the folks at the NPA
as they have experience correcting mechanics of pitchers who have had injuries/health issues.

You may think I’m crazy, but a major league team doesn’t. They think this is something worth looking at when it comes to drafting people.

Chris, I don’t know what the “major league” team feels about diagnosis based on…what? 2 paragraphs? I don’t bust on you and have privately discussed with you on this diagnosis by speculation thing you do. I caution you, this in my opinion is dangerous behavior. I don’t think anyone doubts your desire to assist, but you know literally nothing about this mans son, if he does have a motion resembling Roy Oswalt then what can possibly come out of that in a medically meaningful way. You cannot suppose mechanical flaws without seeing the kids mechanics. I mean he can throw like say Nomo, but remind his dad of Beckett.
I am thrilled for you that you have found yourself a paycheck in MLB, really! But that kind of prideful boasting comes right before a fall, in my experience.

I know I don’t know anything about his son. That’s why I asked to see the video.

He, his son, and his doctor all seem interested in finding out the root cause of the problem, and I’m trying to help.

I’m not trying to boast.

Why I’m trying to do is point out that some very experienced people (more experienced than anyone on this site) have looked at what I’ve been doing and think there’s something to it. They believe that I may in fact be seeing a pattern.

Richard, I’ll echo what Roger says here, if NPA doesn’t have a local guy (They have one fellow here in the big ol state of Florida) look to the universities and colleges in your area, ask the coaches if the schools don’t offer instruction who they would recommend, I believe it crucial to uncover what caused that impingement, that is of course unless you want to replay this drill.

[quote=“Chris O’Leary”]You may think I’m crazy, but a major league team doesn’t. They think this is something worth looking at when it comes to drafting people.[/quote]So, providing actual EVIDENCE isn’t required. Addressing my questions isn’t required. Just because you’ve convinced someone else without evidence doesn’t mean you’re right. You’ve produced absolutely nothing that has convinced me about the validity of your claims. I’ve presented you with what I believe is evidence that you actually are incorrect. You have yet to sufficiently respond to what you’ve been presented with yet we’re all supposed to change everything because of your coincidences.

I have provided evidence. It has convinced a lot of people, including many people who know a lot about baseball. However, I’m not surprised that it hasn’t convinced everyone. Let’s see if my predictions about Anthony Reyes bear out.

Until then, we should teach pitchers to do what HOFers like Greg Maddux and Nolan Ryan did, which is to keep their PAS elbows below their shoulders.

If you guys are going to rip into anyone, why not rip into Paul Nyman and his fans who are teaching that hyperabduction is necessary (they call it “making the upside down w”) despite the fact that…

  1. HOFers like Maddux and Ryan don’t do it.
  2. Their poster children for making the upside down w (e.g. Wagner and Smoltz) have had a series of shoulder problems.

[quote=“Chris O’Leary”]Until then, we should teach pitchers to do what HOFers like Greg Maddux and Nolan Ryan did, which is to keep their PAS elbows below their shoulders.[/quote]Keep it below the shoulder when? Are you ever going to address my pointing out how the elbow is up there only for a short amount of time and is back to shoulder height by the time the forearm gets to a horizontal position? You have consistently ignored that point but we’re still expected to believe your theory. Then you quote a PT who spoke to a completely different potential issue and say that it proves your point, which it just doesn’t. It’s about something different.

What you’re putting out there is a “theory” based on coincidental “patterns”. I will eat my words if you provide actual evidence. Convincing someone else isn’t evidence. Have they looked at the video and observed what I’ve pointed out or are they just impressed by the coincidences? I’d be curious to know what the major league team’s people would say about what I’ve been saying about the timing of the elbow being up at that height. You obviously are not going to address it. Maybe they will.

He, his son, and his doctor all seem interested in finding out the root cause of the problem, and I’m trying to help

I already acknowledged your obvious desire to help Chris, I will reiterate that I don’t think anyone doubts that, what is very objectionable to me is when you take it from a theory and attempt to apply it to Richards situation.
Can I please get you to confirm that it is the most important thing for Richard and son to get better? You made no mention of that in your advice to him.
Yes you did intermingle a vague statement about video while going through your statements about his mechs. but Chris we are talking about someones hopes and dreams here. If in your former life you made an analysis of a photo malpractice potentially ensued, how can our good intentions supercede the need for us to help this kid get to where he wants to go? Thats rhetorical…because you and I both know that this is not the condition or the desired result. Heck as Lil Ricky gets better his mechs may naturally change over that time due to any number of factors, so speculating on whether he looks like Prioe or Dantrelle or Tanner for that matter makes little impact on Lil Ricky getting to the point where he can painlessly perform his art.

I’m not trying to boast.

What it would seem you attempted to do would be to flaunt your new position in the face of a man who has been openly critical of you for this and apparently other reasons. They’ve not been easy on you so your frustration is understandable but being hired by a team to assess photo’s doesn’t give you Carte Blanche with how you approach a hurt kid looking for help, and I don’t doubt that they are pleased with some of your analysis…but I didn’t hear you say you had replaced anyone as a trainer or team doctor.
Sorry Richard to hijack your thread. :oops:

FYI, Reyes already had arm problems in college. So that might be an additional variable in the equation should he become injured.

Predicting a pitcher is going to have arm problems is like predicting someone will lose money in Vegas.

The hard part is predicting who won’t have arm problems.

The Dodgers predicted Pedro Martinez’s arm problems a long time ago, and got rid of him. Problem was that he had a long, very successful career in the meantime.

At some point people have to realize that pitching is hard on the arm and most people are going to have arm problems eventually regardless of mechanics and a very few aren’t. You can’t pick a pitcher and say that throwing like that pitcher will help you avoid arm problems. That rubber armed pitcher may have mechanics that would destroy another pitcher’s arm but simply may heal quicker than most or have stronger tendons or ligaments than most.

Personally, I think that a 5’11" pitcher who used Randy Johnson’s mechanics would be quite unlikely to have arm problems, mostly because they’d be unlikely to throw over 80 mph. Less stress, much shorter career.

Heck, the reality is these days that a pitcher who has undergone TJ may have a higher value than one who hasn’t because he’s probably less likely to need TJ surgery in the future.

That’s why I talk about both the younger guys whose mechanics I don’t like (e.g. Anthony Reyes) and the younger guys whose mechanics I do like…

  • Freddy Garcia
  • Roy Oswalt

Don’t confuse me with Marshall. I don’t hate everyone’s mechanics.

Oswalt is a bit of a slinger and as such likely to have arm problems eventually simply because he throws so hard for his size unless he’s one of those genetic freaks, though he’s been very durable so far. I hope he doesn’t get injured since his arm action is almost identical to my son’s.

Garcia was down with an arm injury in 2000.

See, it is very easy to predict arm injuries. One you’ll have to wait 10 or 15 years to prove me wrong and the other has already injured his arm.