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Articles Tagged Shoulder 

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06-26

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Daily Roundup: Around the League: June 26, 2013
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Clint Chisam

06-24

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Daily Roundup: Around the League: June 24, 2013
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Clint Chisam

06-18

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Daily Roundup: Around the League: June 18, 2013
by
Clint Chisam

06-10

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Daily Roundup: Around the League: June 9, 2013
by
Clint Chisam

05-28

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Daily Roundup: Around the League: May 28, 2013
by
Clint Chisam

05-25

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Daily Roundup: Around the League: May 25, 2013
by
Clint Chisam

05-23

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Daily Roundup: Around the League: May 23, 2013
by
Clint Chisam

05-15

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2

Daily Roundup: Around the League: May 15th, 2013
by
Clint Chisam

04-29

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Daily Roundup: Around the League: April 29, 2013
by
Clint Chisam

04-16

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Daily Roundup: Around the League: April 16, 2013
by
Clint Chisam

04-16

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Collateral Damage Daily: Monday, April 16
by
Corey Dawkins

02-15

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5

Collateral Damage: The DL Kings: Alex Escobar
by
Corey Dawkins

01-06

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Collateral Damage: Rounding Up the Usual Suspects: SLAP Tears
by
Corey Dawkins and Ben Lindbergh

12-16

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8

Collateral Damage: Rounding Up the Usual Suspects: Rotator Cuff Tears
by
Corey Dawkins and Ben Lindbergh

12-05

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7

Collateral Damage: Rounding Up the Usual Suspects: Impingement
by
Corey Dawkins and Ben Lindbergh

11-14

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Collateral Damage: The Season in Injuries: NL East
by
Corey Dawkins and Ben Lindbergh

11-11

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Collateral Damage: The Season in Injuries: NL Central
by
Corey Dawkins

09-26

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Collateral Damage: Crunch Time
by
Corey Dawkins and Ben Lindbergh

09-21

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Collateral Damage: A Pence for the Phillies' Thoughts
by
Corey Dawkins and Ben Lindbergh

09-19

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Collateral Damage: Weakened Swings and Injured Twins
by
Corey Dawkins and Ben Lindbergh

09-06

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Collateral Damage: The Season-Ending Injury Edition
by
Corey Dawkins and Ben Lindbergh

09-02

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Collateral Damage: Marlin Maladies
by
Corey Dawkins and Ben Lindbergh

08-31

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17

Collateral Damage: See You in September?
by
Corey Dawkins and Ben Lindbergh

08-29

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Collateral Damage: The Irene Edition
by
Corey Dawkins and Ben Lindbergh

08-24

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10

Collateral Damage: The Wall Wins Again
by
Corey Dawkins and Ben Lindbergh

08-22

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Collateral Damage: One Wrong Move
by
Corey Dawkins and Ben Lindbergh

08-17

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18

Collateral Damage: Giant Problems
by
Corey Dawkins and Ben Lindbergh

08-05

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Collateral Damage: Shoulder Woes
by
Corey Dawkins and Ben Lindbergh

08-03

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8

Collateral Damage: Dodger Damages
by
Corey Dawkins and Ben Lindbergh

07-27

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Collateral Damage: Keeping Up with the Jones
by
Corey Dawkins and Ben Lindbergh

07-25

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Collateral Damage: Overextended
by
Corey Dawkins and Ben Lindbergh

06-29

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Collateral Damage: Pinpointing Pitcher Injuries
by
Corey Dawkins and Ben Lindbergh

06-20

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Collateral Damage: X-rays for Albert
by
Corey Dawkins and Ben Lindbergh

06-10

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Collateral Damage: Pennant Race Pains
by
Corey Dawkins and Ben Lindbergh

05-23

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8

Collateral Damage: Of the Byrds and the Beaned
by
Corey Dawkins and Ben Lindbergh

05-11

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13

Collateral Damage: Elbowed Out and Shouldered Aside
by
Corey Dawkins and Marc Normandin

04-25

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Collateral Damage: Debriding Our Time
by
Corey Dawkins and Marc Normandin

04-20

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Collateral Damage: Fools Rush In
by
Corey Dawkins and Marc Normandin

04-08

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Collateral Damage: Cuffed Around
by
Corey Dawkins and Marc Normandin

03-31

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Team Injury Projection: Oakland Athletics
by
Corey Dawkins and Marc Normandin

03-30

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11

Collateral Damage: Disabled on Opening Day
by
Corey Dawkins and Marc Normandin

03-23

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Collateral Damage: Show and Patella
by
Corey Dawkins and Marc Normandin

03-18

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Team Injury Projection: Chicago Cubs
by
Corey Dawkins and Marc Normandin

02-25

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8

Collateral Damage: Springing for Surgery
by
Corey Dawkins and Marc Normandin

09-27

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14

Under The Knife: A Small Part Of Tenth Inning
by
Will Carroll

09-17

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13

Under The Knife: Is Ryan's Way Working?
by
Will Carroll

09-15

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Under The Knife: About Those Pitch Counts
by
Will Carroll

09-13

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Under The Knife: Not So Dangerous Times
by
Will Carroll

09-06

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Under The Knife: A Difficult Task
by
Will Carroll

08-30

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Under The Knife: Looking for a Strasburg Scapegoat
by
Will Carroll

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The skinny on an elusive injury that increasingly plagues pitchers.

Superior Labrum Anterior to Posterior (SLAP) tears are an increasingly common injury in baseball players. Much more common in throwing athletes than non-throwers, SLAP lesions have gained a lot more attention as baseball pitchers have been studied in greater detail.

Anatomy
As we described in a previous article, the shoulder is made up of three bones but many different soft tissues. The clavicle, scapula, and humerus serve as attachment sites for the various muscles, ligaments, tendons, and nerves in order for proper function to occur. In the case of SLAP lesions, we are most interested in the labrum and the tendon of the long head of the biceps.


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A rotator cuff tears isn't a death sentence for a pitcher's career, but it's far from a positive prognosis.

Baseball pitchers and rotator cuff problems seem to go hand-in-hand despite the rotator cuff being much smaller than other muscles about the shoulder and upper back. The four small muscles that make up the rotator cuff are vital to the shoulder’s health and to a pitcher’s playing career. In fact, at one time, rotator cuff surgery was considered a career-ending sentence. That isn’t the case any longer, but it still hasn’t reached the level of relative certainty of ACL surgery or even Tommy John surgery. Without a healthy rotator cuff, a significant cascade effect culminating in shoulder instability and/or tears of the labrum is possible, if not inevitable. In today’s episode of Collateral Damage, we will be looking at the rotator cuff and ways of treating it in all of their complexity.

Anatomy
The rotator cuff is made up of four muscles that attach at different sites on the scapula, a.k.a. the shoulder blade. These four muscles are known as the supraspinatus, infraspinatus, teres minor, and subscapularis. The main function of the rotator cuff as a group is to ensure that the humeral head stays centralized in the glenoid fossa. This cannot be emphasized enough. Two of the muscles—infraspinatus and teres minor—assist in external rotation of the shoulder, while the subscapularis is the only rotator cuff muscle whose role is as an internal rotator. The supraspinatus also assists in abduction, especially early in the motion. Without that rotator cuff, the humeral head would slide all over the place and tear up the labrum, articular cartilage, and other tendons in the area.
 



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Kicking off a series on the most most frequently suffered baseball injuries with a look at a common shoulder complaint for pitchers.

This article on impingement kicks off an in-depth series on some of the most common injuries we see in baseball. While impingement is an official diagnosis, it describes a dynamic process or a collection of conditions rather than a single end result, such as a torn ACL. Complicating matters for the fans is the fact that the end result is what is usually reported. Pedro Martinez and his case of rotator cuff inflammation, which developed into a partial rotator cuff tear? Impingement played a role. Martinez is an extreme example of how shoulder impingement can derail a career, but how many times have we heard of a pitcher developing rotator cuff inflammation and spending more time on the disabled list than expected?

Brief Anatomy
There are actually four different joints that make up the shoulder complex: glenohumeral, scapulothoracic, acromioclavicular, and sternoclavicular. Each of these must be functioning properly in order for the shoulder to function normally while performing baseball activities. The sternoclavicular (SC) joint is the only joint connecting the shoulder to the axial skeleton. The medial end of the clavicle attaches to the sternum with a cushioning disc between them, much like a meniscus, which provides a very strong connection that takes a large amount of force to injure. The joint is further strengthened by very strong ligaments. The other three joints are the ones we are most concerned with when discussing impingement.


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November 14, 2011 9:00 am

Collateral Damage: The Season in Injuries: NL East

9

Corey Dawkins and Ben Lindbergh

The NL East was in bad shape in 2011, and the team that brought up the rear was exactly the one you'd think.

Division: National League East

WARP lost Divisional Ranking (Overall Ranks—Best to worst):

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November 11, 2011 10:19 am

Collateral Damage: The Season in Injuries: NL Central

17

Corey Dawkins

The Astros find something they're finally the best at, and the Cards manage to win the World Series despite huge losses to injury

Division: National League Central

Divisional Ranking for WARP Lost (MLB Rank, best to worst):

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Peter Moylan can't catch a break, Denard Span gets into a car crash and emerges with a headache, Daric Barton and Miguel Cairo undergo shoulder surgery, Tim Hudson gets dehydrated, and Scott Atchison strains his groin.

Peter Moylan, ATL (Right shoulder torn labrum and rotator cuff) [AGL: 10 (93 DL), ATD: TBD (-.092 DL)] (Explanation)
Moylan can’t seem to catch a break in 2011. After missing four months following surgery on a troublesome disc in his low back, his shoulder started to click on him during normal next day throwing after last Monday’s appearance. Clicking can be indicative of several different problems, ranging from swelling to full blown cartilage tears. However, over this past offseason, he underwent an MRI that revealed tearing in his rotator cuff and labrum.

A recent repeat MRI on Thursday revealed that the tearing has worsened and may require surgery. He will see noted surgeon Dr. James Andrews down in Birmingham for a second opinion, and it sounds like he will need surgery. Surgery will almost certainly put him out for most of the 2012 season, barring some unexpected good news. He doesn’t have to have surgery, but he is risking significantly more damage in his shoulder if he chooses to pursue the rehab route. 


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September 21, 2011 9:00 am

Collateral Damage: A Pence for the Phillies' Thoughts

0

Corey Dawkins and Ben Lindbergh

Hunter Pence attempts to stay in play for the playoffs, Pablo Sandoval continues to battle a strained shoulder, Cody Ross hits the comeback trail, Asdrubal Cabrera fends off the end of his season, and Kerry Wood gives up the ghost.

Pablo Sandoval, SFN (Left shoulder strain) [AGL: 3 (29 DL), ATD: -.002 (+.031 DL)] (Explanation)
When Sandoval strained his shoulder in mid-August, few were expecting him to be limited for the remainder of the year as he has been. Still unable to hit from the right side because of the left shoulder pain, Sandoval may end up needing surgery after the season is completed. Typically, this mechanism of injury—Sandoval injured the left shoulder batting right-handed—is more indicative of instability or a partially torn labrum than a partial muscle tear.

In some cases, the ligaments and capsule are stretched and can be painful, while at other times the capsule and ligaments can be torn and end up needing to be stitched or anchored to bone for proper healing. The labrum can tear with a similar mechanism of injury and lead to deep pain and “something not feeling right” inside the shoulder itself.


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September 19, 2011 9:00 am

Collateral Damage: Weakened Swings and Injured Twins

1

Corey Dawkins and Ben Lindbergh

Adrian Gonzalez suffers a power outage, Justin Morneau continues to suffer concussion symptoms, Joe Mauer has pneumonia, Dan Cortes breaks his hand under mysterious circumstances, Cody Ross strains a hamstring, and more.

Adrian Gonzalez, BOS (Right shoulder weakness) [AGL: 5 (TBD DL), ATD: +.180 (TBD DL)] (Explanation)
Gonzalez’s power numbers have dropped in the second half of the year, and it looks like we finally have an explanation. On top of poor pitch selection, Gonzalez is battling weakness in his right shoulder that he admits may be costing him opposite field power. He has not been taking batting practice on the field for over a month now as he’s tried to strengthen his shoulder for the stretch drive.

While it’s certainly not uncommon for players to suffer fatigue or weakness at this time of year, people are concerned because of Gonzalez’s injury history, which could make his case similar to Joe Mauer’s fatigue following off-season knee surgery. Gonzalez may not have been able to rehab the shoulder fully, and he could have hit the proverbial wall.


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September 6, 2011 5:00 am

Collateral Damage: The Season-Ending Injury Edition

1

Corey Dawkins and Ben Lindbergh

Hanley Ramirez moves closer to surgery, Brennan Boesch won't be around for October, Franklin Gutierrez's lost season gets worse, Mike Stanton strains a hamstring, and Conor Jackson kicks off his Boston career by running into a wall.

Hanley Ramirez, FLO (Left shoulder surgery—instability) [AGL: 94, ATD: +.065] (Explanation)
As the situation with Ramirez's shoulder progresses, we're finding out more about his options. In light of the mechanism of injury, we know the shoulder is unstable in at least the anterior direction. As with any injury, there is the option of not doing anything and continuing to rehabilitate the shoulder in the hope that it gets strong enough. Ramirez has already pursued that option, and the shoulder continued to be unstable, even on practice swings. That leaves us two surgical options that Ramirez is also considering: arthroscopic and open.

Arthroscopic procedures are minimally invasive and generally have a shorter recovery time. Small incisions are made in the shoulder to allow the instruments to be passed into the shoulder. Before addressing any repair of the capsule itself, the surgeon will take a look at the labrum, rotator cuff, and articular cartilage on the end of the humerus. If any of these is injured, repair of that structure will ensue.


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September 2, 2011 9:00 am

Collateral Damage: Marlin Maladies

0

Corey Dawkins and Ben Lindbergh

We finally learn what's really ailing HanRam, Josh Johnson is done for the year, J.D. Drew is up to his old injury tricks, and Jair Jurrjens' season is in jeopardy.

Hanley Ramirez, FLO (Left shoulder instability) [AGL: 16, ATD: +.030] (Explanation)
The full extent of Ramirez's problems have come to light, and as we expected, he was dealing with more than a simple sprain. It's now been reported that the MRI has shown shoulder “instability,” and Ramirez will be meeting with team physician Dr. Lee Kaplan to discuss the options from here. One thing needs to be cleared up, though: shoulder MRIs don't directly show instability. They reveal injuries and findings consistent with instability, such as sprains of certain ligaments or tearing of the capsule.

The reports of Ramirez not having any structural damage are also somewhat misleading, given the anatomy and lack of bony stability in the shoulder. There can be soft tissue injuries that don't allow a baseball player to function, but they aren’t considered structural issues. The diagnosis of instability relates to symptoms associated with abnormal looseness of a joint and is somewhat dependent on subjective reports of popping out of the shoulder, pain, and other symptoms. It's not like looking at a knee MRI and seeing a torn ACL.


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August 31, 2011 5:00 am

Collateral Damage: See You in September?

17

Corey Dawkins and Ben Lindbergh

Nelson Cruz's old injury enemy strikes again, Darren O'Day tries to return for the stretch run, Brennan Boesch attempts to avoid surgery, Justin Morneau misses times amidst conflicting reports, Hanley Ramirez's shoulder woes could be more serious than initially believed, and the odds are against Pedro Feliciano.

Pedro Feliciano, NYA (Left shoulder capsule sprain) [AGL: 145, ATD: +.081] (Explanation)

Feliciano has spent the season on the disabled list trying anything possible to avoid undergoing a surgery whose previous recipients include Chien-Ming Wang, Scott Elarton, Johan Santana, and Dallas Braden. The shoulder capsule plays a role in the joint’s tensile stability during rotational movements, and it also creates a negative pressure inside the shoulder joint, further stabilizing it.

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August 29, 2011 9:00 am

Collateral Damage: The Irene Edition

0

Corey Dawkins and Ben Lindbergh

An injured wrist ends Michael Brantley's season, Tommy Hanson discovers what ails him, Carlos Lee sprains an ankle, and the rest of the injuries around the league.

With Corey’s laptop battery the latest casualty of Hurricane/Tropical Storm Irene, we’re in for a shorter-than-usual edition of Collateral Damage today. Thankfully, the injury gods have cooperated.

Michael Brantley, CLE (Right wrist surgery—hamate) [AGL: 51, ATD: +.044] (Explanation)
After trying to battle through right wrist inflammation for several weeks, Brantley finally ended up on the disabled list on Friday. All of the basic tests were negative or inconclusive, but clearly something was causing his continued pain and inflammation. When his wrist first started bothering him back in early August, it looked like a typical case of tendinitis and was treated as such. The problem is that the wrist can act like the shoulder, in that tendinitis often masks injuries to other structures. Brantley's wrist responded to treatment over the first few weeks, when he was in and out of the lineup, but it began presenting differently to the medical staff over subsequent weeks.


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