Skip to main content
Top
Published in: Clinical Orthopaedics and Related Research® 6/2012

01-06-2012 | Symposium: Injuries in Overhead Athletes

‘Batter’s Shoulder’: Can Athletes Return to Play at the Same Level After Operative Treatment?

Authors: Tony Wanich, MD, Joshua Dines, MD, David Dines, MD, Ralph A. Gambardella, MD, Lewis A. Yocum, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 6/2012

Login to get access

Abstract

Background

Batter’s shoulder has been defined as posterior subluxation of the lead shoulder during the baseball swing. However, it is unclear whether or how frequently patients may return to play after treatment of this uncommon condition.

Questions/purposes

We therefore determined the rate of return to play after operative treatment for Batter’s shoulder and whether ROM was restored.

Methods

We retrospectively reviewed the records of 14 baseball players diagnosed with Batter’s shoulder. Four played professionally, six were in college, and four were in varsity high school. The average age was 20.3 years (range, 16–33 years). All had physical examinations and MRI findings consistent with posterior labral tears involving the lead shoulder. Treatment involved arthroscopic posterior labral repair (n = 10), débridement (n = 2), or rehabilitation (n = 2). The minimum followup was 18 months (average, 2.8 years; range, 18–64 months).

Results

Eleven of 12 surgically treated patients returned to their previous level of batting at an average of 5.9 months after surgery. The one patient who was unable to return to play also had an osteochondral lesion of the glenoid identified at surgery. Players typically returned to hitting off a tee at 3 months and to facing live pitching at 6 months postoperatively. All patients regained full internal and external ROM as compared with preoperative data.

Conclusions

Batter’s shoulder is an uncommon form of posterior instability in hitters affecting their lead shoulder. Most athletes are able to return to play at the same level after arthroscopic treatment of posterior capsulolabral lesions.

Level of Evidence

Level IV, case series. See Guidelines for Authors for a complete description of levels of evidence.
Literature
1.
go back to reference Altchek DW, Warren RF, Skyhar MJ, Ortiz G. T-plasty modification of the Bankart procedure for multidirectional instability of the anterior and inferior types. J Bone Joint Surg Am. 1991;73:105–112.PubMed Altchek DW, Warren RF, Skyhar MJ, Ortiz G. T-plasty modification of the Bankart procedure for multidirectional instability of the anterior and inferior types. J Bone Joint Surg Am. 1991;73:105–112.PubMed
2.
3.
go back to reference Bottoni CR, Franks BR, Moore JH, DeBerardino TM, Taylor DC, Arciero RA. Operative stabilization of posterior shoulder instability. Am J Sports Med. 2005;33:996–1002.PubMedCrossRef Bottoni CR, Franks BR, Moore JH, DeBerardino TM, Taylor DC, Arciero RA. Operative stabilization of posterior shoulder instability. Am J Sports Med. 2005;33:996–1002.PubMedCrossRef
4.
go back to reference Bowers AL, Dines JS, Dines DM, Altchek DW. Elbow medial ulnar collateral ligament reconstruction: clinical relevance and the docking technique. J Shoulder Elbow Surg. 2010;19:110–117.PubMedCrossRef Bowers AL, Dines JS, Dines DM, Altchek DW. Elbow medial ulnar collateral ligament reconstruction: clinical relevance and the docking technique. J Shoulder Elbow Surg. 2010;19:110–117.PubMedCrossRef
5.
go back to reference Bradley JP, Baker CL 3rd, Kline AJ, Armfield DR, Chhabra A. Arthroscopic capsulolabral reconstruction for posterior instability of the shoulder: a prospective study of 100 shoulders. Am J Sports Med. 2006;34:1061–1071.PubMedCrossRef Bradley JP, Baker CL 3rd, Kline AJ, Armfield DR, Chhabra A. Arthroscopic capsulolabral reconstruction for posterior instability of the shoulder: a prospective study of 100 shoulders. Am J Sports Med. 2006;34:1061–1071.PubMedCrossRef
6.
go back to reference Bradley JP, Tejwani SG. Arthroscopic management of posterior instability. Orthop Clin North Am. 2010;41:339–356.PubMedCrossRef Bradley JP, Tejwani SG. Arthroscopic management of posterior instability. Orthop Clin North Am. 2010;41:339–356.PubMedCrossRef
7.
go back to reference Buck CJ, American Medical Association. 2011 ICD-9-CM, Volumes 1 & 2 for Physicians. St Louis, MO, Chicago, IL, USA: Elsevier/Saunders; American Medical Association; 2011. Buck CJ, American Medical Association. 2011 ICD-9-CM, Volumes 1 & 2 for Physicians. St Louis, MO, Chicago, IL, USA: Elsevier/Saunders; American Medical Association; 2011.
8.
go back to reference Conway JE, Jobe FW, Glousman RE, Pink M. Medial instability of the elbow in throwing athletes. Treatment by repair or reconstruction of the ulnar collateral ligament. J Bone Joint Surg Am. 1992;74:67–83.PubMed Conway JE, Jobe FW, Glousman RE, Pink M. Medial instability of the elbow in throwing athletes. Treatment by repair or reconstruction of the ulnar collateral ligament. J Bone Joint Surg Am. 1992;74:67–83.PubMed
9.
go back to reference Dines JS, ElAttrache NS, Conway JE, Smith W, Ahmad CS. Clinical outcomes of the DANE TJ technique to treat ulnar collateral ligament insufficiency of the elbow. Am J Sports Med. 2007;35:2039–2044.PubMedCrossRef Dines JS, ElAttrache NS, Conway JE, Smith W, Ahmad CS. Clinical outcomes of the DANE TJ technique to treat ulnar collateral ligament insufficiency of the elbow. Am J Sports Med. 2007;35:2039–2044.PubMedCrossRef
10.
go back to reference Fleisig GS, Dun S, Kingsley D. Biomechanics of the shoulder during sports. In: Wilk KE, Reinold MM, Andrews JR, eds. The Athlete’s Shoulder. Philadelphia, PA, USA: Churchill Livingstone; 2009:380. Fleisig GS, Dun S, Kingsley D. Biomechanics of the shoulder during sports. In: Wilk KE, Reinold MM, Andrews JR, eds. The Athlete’s Shoulder. Philadelphia, PA, USA: Churchill Livingstone; 2009:380.
11.
go back to reference Guanche CA, Jones DC. Clinical testing for tears of the glenoid labrum. Arthroscopy. 2003;19:517–523.PubMedCrossRef Guanche CA, Jones DC. Clinical testing for tears of the glenoid labrum. Arthroscopy. 2003;19:517–523.PubMedCrossRef
12.
go back to reference Kaplan LD, Flanigan DC, Norwig J, Jost P, Bradley J. Prevalence and variance of shoulder injuries in elite collegiate football players. Am J Sports Med. 2005;33:1142–1146.PubMedCrossRef Kaplan LD, Flanigan DC, Norwig J, Jost P, Bradley J. Prevalence and variance of shoulder injuries in elite collegiate football players. Am J Sports Med. 2005;33:1142–1146.PubMedCrossRef
13.
go back to reference Kim SH, Ha KI, Park JH, Kim YM, Lee YS, Lee JY, Yoo JC. Arthroscopic posterior labral repair and capsular shift for traumatic unidirectional recurrent posterior subluxation of the shoulder. J Bone Joint Surg Am. 2003;85:1479–1487.PubMedCrossRef Kim SH, Ha KI, Park JH, Kim YM, Lee YS, Lee JY, Yoo JC. Arthroscopic posterior labral repair and capsular shift for traumatic unidirectional recurrent posterior subluxation of the shoulder. J Bone Joint Surg Am. 2003;85:1479–1487.PubMedCrossRef
14.
go back to reference Lovett RW, Martin EG. Certain aspects of infantile paralysis (with a descrition of a method of muscle testing). JAMA. 1916;66:729–733.CrossRef Lovett RW, Martin EG. Certain aspects of infantile paralysis (with a descrition of a method of muscle testing). JAMA. 1916;66:729–733.CrossRef
15.
go back to reference Mair SD, Zarzour RH, Speer KP. Posterior labral injury in contact athletes. Am J Sports Med. 1998;26:753–758.PubMed Mair SD, Zarzour RH, Speer KP. Posterior labral injury in contact athletes. Am J Sports Med. 1998;26:753–758.PubMed
16.
go back to reference Meserve BB, Cleland JA, Boucher TR. A meta-analysis examining clinical test utility for assessing superior labral anterior posterior lesions. Am J Sports Med. 2009;37:2252–2258.PubMedCrossRef Meserve BB, Cleland JA, Boucher TR. A meta-analysis examining clinical test utility for assessing superior labral anterior posterior lesions. Am J Sports Med. 2009;37:2252–2258.PubMedCrossRef
17.
go back to reference Nord KD, Brady PC, Yazdani RS, Burkhart SS. The anatomy and function of the low posterolateral portal in addressing posterior labral pathology. Arthroscopy. 2007;23:999–1005.PubMedCrossRef Nord KD, Brady PC, Yazdani RS, Burkhart SS. The anatomy and function of the low posterolateral portal in addressing posterior labral pathology. Arthroscopy. 2007;23:999–1005.PubMedCrossRef
18.
go back to reference O’Brien SJ, Pagnani MJ, Fealy S, McGlynn SR, Wilson JB. The active compression test: a new and effective test for diagnosing labral tears and acromioclavicular joint abnormality. Am J Sports Med. 1998;26:610–613.PubMed O’Brien SJ, Pagnani MJ, Fealy S, McGlynn SR, Wilson JB. The active compression test: a new and effective test for diagnosing labral tears and acromioclavicular joint abnormality. Am J Sports Med. 1998;26:610–613.PubMed
19.
go back to reference Philips BB, Andrews JR, Fleisig GS. Batter’s Shoulder: Posterior Instability of the Lead Shoulder, A Biomechanical Evaluation. Birmingham, AL, USA: Alabama Sports Medicine and Orthopaedic Center; 2000. Philips BB, Andrews JR, Fleisig GS. Batter’s Shoulder: Posterior Instability of the Lead Shoulder, A Biomechanical Evaluation. Birmingham, AL, USA: Alabama Sports Medicine and Orthopaedic Center; 2000.
20.
go back to reference Provencher MT, Bell SJ, Menzel KA, Mologne TS. Arthroscopic treatment of posterior shoulder instability: results in 33 patients. Am J Sports Med. 2005;33:1463–1471.PubMedCrossRef Provencher MT, Bell SJ, Menzel KA, Mologne TS. Arthroscopic treatment of posterior shoulder instability: results in 33 patients. Am J Sports Med. 2005;33:1463–1471.PubMedCrossRef
21.
go back to reference Provencher MT, Leclere LE, King S, Frank RM, Mologne TS, Ghodadra NS, Romeo AA. Posterior instability of the shoulder: diagnosis and management. Am J Sports Med. 2011;39:874–886.PubMedCrossRef Provencher MT, Leclere LE, King S, Frank RM, Mologne TS, Ghodadra NS, Romeo AA. Posterior instability of the shoulder: diagnosis and management. Am J Sports Med. 2011;39:874–886.PubMedCrossRef
22.
go back to reference Radkowski CA, Chhabra A, Baker CL, Tejwani SG, Bradley JP. Arthroscopic capsulolabral repair for posterior shoulder instability in throwing athletes compared with nonthrowing athletes. Am J Sports Med. 2008;36:693–699.PubMedCrossRef Radkowski CA, Chhabra A, Baker CL, Tejwani SG, Bradley JP. Arthroscopic capsulolabral repair for posterior shoulder instability in throwing athletes compared with nonthrowing athletes. Am J Sports Med. 2008;36:693–699.PubMedCrossRef
23.
go back to reference Shaffer B, Jobe FW, Pink M, Perry J. Baseball batting. An electromyographic study. Clin Orthop Relat Res. 1993;292:285–293.PubMed Shaffer B, Jobe FW, Pink M, Perry J. Baseball batting. An electromyographic study. Clin Orthop Relat Res. 1993;292:285–293.PubMed
24.
go back to reference Silliman JF, Hawkins RJ. Classification and physical diagnosis of instability of the shoulder. Clin Orthop Relat Res. 1993;291:7–19.PubMed Silliman JF, Hawkins RJ. Classification and physical diagnosis of instability of the shoulder. Clin Orthop Relat Res. 1993;291:7–19.PubMed
25.
go back to reference Tibone JE, Bradley JP. The treatment of posterior subluxation in athletes. Clin Orthop Relat Res. 1993;291:124–137.PubMed Tibone JE, Bradley JP. The treatment of posterior subluxation in athletes. Clin Orthop Relat Res. 1993;291:124–137.PubMed
26.
go back to reference Welch CM, Banks SA, Cook FF, Draovitch P. Hitting a baseball: a biomechanical description. J Orthop Sports Phys Ther. 1995;22:193–201.PubMed Welch CM, Banks SA, Cook FF, Draovitch P. Hitting a baseball: a biomechanical description. J Orthop Sports Phys Ther. 1995;22:193–201.PubMed
27.
go back to reference Williams RJ 3rd, Strickland S, Cohen M, Altchek DW, Warren RF. Arthroscopic repair for traumatic posterior shoulder instability. Am J Sports Med. 2003;31:203–209.PubMed Williams RJ 3rd, Strickland S, Cohen M, Altchek DW, Warren RF. Arthroscopic repair for traumatic posterior shoulder instability. Am J Sports Med. 2003;31:203–209.PubMed
28.
go back to reference Wolf EM, Eakin CL. Arthroscopic capsular plication for posterior shoulder instability. Arthroscopy. 1998;14:153–163.PubMedCrossRef Wolf EM, Eakin CL. Arthroscopic capsular plication for posterior shoulder instability. Arthroscopy. 1998;14:153–163.PubMedCrossRef
Metadata
Title
‘Batter’s Shoulder’: Can Athletes Return to Play at the Same Level After Operative Treatment?
Authors
Tony Wanich, MD
Joshua Dines, MD
David Dines, MD
Ralph A. Gambardella, MD
Lewis A. Yocum, MD
Publication date
01-06-2012
Publisher
Springer-Verlag
Published in
Clinical Orthopaedics and Related Research® / Issue 6/2012
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-012-2264-0

Other articles of this Issue 6/2012

Clinical Orthopaedics and Related Research® 6/2012 Go to the issue