Common Injuries for Pitchers
Throwing a baseball pitch is not a natural motion. The repetitive stress of throwing puts strain on the shoulder, elbow, wrist, and hand, affecting the ligaments, tendons, and muscles in these areas. As a result, pitchers sustain injuries at a higher percentage than position players.
This past fall, I pitched complete games two weeks in a row and threw more pitches in those two games than ever before. As a result, I ended up with pain in the elbow of my throwing arm. Fortunately, I did not do any real damage to it, but it took two weeks of rest to get back on the mound. Not all MLB players are as fortunate. Pitchers like Shohei Ohtani, Jacob deGrom, Walker Buehler, and others have all undergone season-ending surgeries, usually the Tommy John Surgery. Statistics show that one-third of all MLB pitchers have had this operation..
Pitchers report for spring training in mid-February, so I thought I would talk about the most common injuries suffered by MLB pitchers, including their causes, ways of prevention, and treatments:
1. Ulnar Collateral Ligament (UCL) Tear
Cause: Repetitive stress on the elbow from pitching.
Prevention: Proper mechanics, pitch count limits, rest, and strengthening exercises for the forearm and shoulder.
Treatment: Physical therapy, rest, and in severe cases, Tommy John Surgery (UCL reconstruction).
Tommy John Surgery (UCL Reconstruction) for MLB Pitchers
What is it?
Tommy John Surgery is a procedure to repair a torn ulnar collateral ligament (UCL) in the elbow, which is common in MLB pitchers due to the extreme stress of repetitive throwing. The surgery involves replacing the damaged ligament with a tendon from another part of the body (often the forearm, hamstring, or foot). Tommy John surgery requires a long recovery process, typically 12-18 months before a full return to competition.
Causes of UCL Tears
Repetitive high-stress throwing (e.g., fastballs, sliders).
Poor mechanics or overuse, especially in young pitchers.
Sudden trauma from an awkward throw or excessive force.
Signs & Symptoms of a UCL Tear
Pain on the inner elbow (especially when throwing).
Decreased velocity and control.
Numbness or tingling in the hand.
A "pop" sensation in severe cases.
Success Rate & Risks
80-90% of pitchers return to pre-injury performance or better.
Some pitchers throw even harder post-surgery due to improved mechanics and rehab.
Risks include infection, nerve damage, or failure of the graft.
2. Rotator Cuff Strain/Tear
Cause: Overuse and high-intensity throwing motions.
Prevention: Shoulder strengthening, flexibility exercises, proper warm-up, and mechanics.
Treatment: Rest, physical therapy, anti-inflammatory meds, and in severe cases, surgery.
Rotator Cuff Tear in MLB Pitchers
What is the Rotator Cuff?
The rotator cuff is a group of four muscles and tendons in the shoulder that help stabilize and rotate the arm. Pitchers rely heavily on these muscles for throwing, making them vulnerable to injury. It takes approximately 9-12 months to fully recover and return to 100% pitching.
Causes of a Rotator Cuff Tear
Overuse & Repetitive Throwing – Constant stress from pitching can cause micro-tears.
Poor Mechanics – Incorrect throwing form increases strain on the shoulder.
Muscle Imbalance or Weakness – Weak stabilizer muscles force the rotator cuff to overcompensate.
Lack of Shoulder Mobility – Tightness in the shoulder and chest muscles can lead to impingement.
Symptoms of a Rotator Cuff Tear
Pain in the Shoulder (especially when throwing or lifting the arm).
Weakness in the Shoulder & Arm (difficulty with overhead movements).
Loss of Velocity & Control due to reduced shoulder strength.
Clicking or Popping Sounds when moving the arm.
Treatment for a Rotator Cuff Tear
Non-Surgical Treatment (for Partial Tears)
Rest & Activity Modification – Stop throwing to allow healing.
Physical Therapy – Strengthening exercises for the shoulder, rotator cuff, and scapular muscles.
Anti-Inflammatory Medications – To reduce pain and swelling.
Cortisone Injections – Can temporarily relieve pain but may weaken the tendon if overused.
Platelet-Rich Plasma (PRP) Therapy – Some players opt for PRP injections to speed up healing.
Surgical Treatment (for Full Tears or Severe Cases)
Arthroscopic Rotator Cuff Repair – The surgeon uses small instruments to reattach the torn tendon to the bone.
Open Shoulder Surgery (in rare cases) – Used if the tear is large and requires more extensive reconstruction.
3. Labrum Tear (SLAP Tear - Superior Labrum Anterior and Posterior)
Cause: Repetitive overhead throwing, leading to shoulder instability.
Prevention: Strengthening the shoulder, maintaining good posture, avoiding excessive workload.
Treatment: Rest, rehab exercises, injections, and sometimes surgery.
Labrum Tear (SLAP Tear) in MLB Pitchers
What is the Labrum?
The labrum is a ring of cartilage that lines the shoulder socket (glenoid) and helps stabilize the joint. A SLAP tear (Superior Labrum Anterior and Posterior) is the most common type for pitchers, where the top part of the labrum is torn from front to back. A labrum tear is one of the toughest injuries for pitchers to recover from, with some struggling to regain pre-injury performance. However, proper rehab and strengthening can improve the chances of a successful return. Returning to competitive pitching can take anywhere from 9 to more than 12 months.
Causes of a Labrum Tear in Pitchers
Repetitive Overhead Throwing – The high velocity and torque of pitching stress the labrum.
Poor Mechanics – Increased strain on the shoulder due to improper motion.
Sudden Traumatic Injury – A violent throw or a fall on an outstretched arm.
Symptoms of a Labrum Tear
Deep Shoulder Pain (especially during or after throwing).
Decreased Velocity & Control due to instability.
Clicking or Popping Sensation in the shoulder.
Weakness & Fatigue – The arm may feel "dead" after throwing.
Treatment for a Labrum Tear
Non-Surgical Treatment (for Minor Tears)
Rest & Activity Modification – Stop throwing to prevent further damage.
Physical Therapy – Strengthening the rotator cuff and scapular muscles.
Anti-Inflammatory Medications – To manage pain and swelling.
Cortisone or PRP Injections – Can help reduce inflammation and promote healing.
Surgical Treatment (for Severe Tears)
Arthroscopic Labrum Repair – Surgeons use small anchors to reattach the torn labrum.
Labral Debridement (Cleaning the Tear) – In cases where the labrum is frayed but not fully detached.
4. Shoulder Impingement
Cause: Inflammation of tendons in the shoulder from repeated overhead motions.
Prevention: Strength training, maintaining shoulder mobility, avoiding overuse.
Treatment: Rest, ice, anti-inflammatory medication, and rehab exercises.
5. Flexor Tendon Strain
Cause: Overuse of forearm muscles that stabilize the elbow.
Prevention: Strengthening wrist and forearm muscles, limiting pitch count, proper warm-up.
Treatment: Rest, therapy, and sometimes PRP (Platelet-Rich Plasma) injections.
6. Shoulder/Elbow Stress Fractures
Cause: Repeated high-velocity throwing, causing microfractures in bones.
Prevention: Proper workload management, cross-training, and rest periods.
Treatment: Rest, sometimes surgery if severe.
7. Oblique Strains
Cause: Twisting motions during pitching.
Prevention: Core strengthening, flexibility training, avoiding sudden increases in intensity.
Treatment: Rest, core rehab, and gradual return to throwing.
8. Thoracic Outlet Syndrome (TOS)
Cause: Compression of nerves or blood vessels in the shoulder.
Prevention: Shoulder mobility work, avoiding excessive muscle tightness, and proper mechanics.
Treatment: Therapy, injections, and sometimes surgery to remove a rib or release pressure.
General Prevention Tips for Pitchers:
Follow Pitch Counts & Rest Days: talk to your pitching coach about mapping out an ideal plan based on whether you are a starting pitcher or a reliever
Strengthen the Shoulder, Core, and Forearm: talk to a strength and conditioning specialist to develop a routine appropriate for your age and body type
Use Proper Throwing Mechanics: work with your pitching coach to develop proper form
Warm-Up & Cool Down Properly: develop proper hydration, stretching, and long throw routine for warm-up as well as a recovery program
Listen to Pain – Don’t Throw Through It: don’t try and be a hero, if it hurts tell your coach
