Erik Bedard Injury Information

Today another piece of the Erik Bedard puzzle finally came to light courtesy of the Seattle - Post Intelligencer and that is he has internal impingement. Some places are describing this as merely soreness but nothing can be further from the truth. Internal impingement is a discernible pathology and one that is relatively serious for baseball pitchers.

First it is probably close to the leading cause of pain in the top back of shoulders in pitchers. Often times it's diagnosed as rotator cuff tendinitis. Internal impingement is where both the labrum and the rotator cuff tendons are involved and they get pinched between the head of humerus (the arm bone) and the acromion process of the shoulder blade (the bone on the very top outside of your shoulder).

Usually in pitchers it's because of the result of several things. One potential cause is the muscle weakness, in particular the subscapularis due to many minute traumas during pitching. This tends to be aggrevated during the cocking phase of throwing which occurs when the pitcher brings the arm out of the glove and lasts until the arm begins to accelerate forward. What happens is the muscle weakness cause the humeral head to slide around. This causes inflmmation and pain. The pain and inflammation causes the body to alter the motion and not use the muscles as much. This causes further weakening and the process kind of feeds into itself and snowballs out of control. When the shoulder blade muscles are weak, the shoulder blade moves around too much and it doesn't have a stable base or stay in the proper position. People who have rounded shoulders and/or slouch forward often have this problem.

Another potential cause is instability in the ligaments and joint capsule. During the throwing motion the same things happen. The range of motion that occurs during throwing stretches the ligaments over time which causes further instability. This instability can cause weakening of the muscles as noted above which can lead to further problems.

Another potential cause/problem is fraying at the top of the labrum. When this occurs the pinching of the tip of the labrum eventually begins to wear it down and break up the top of the labrum. This results in a loss of stability of the shoulder moving up which causes even further pinching. Again, it goes into a feedback mechanism where it gets worse and worse.

Summary: Shoulder injuries with baseball pitchers need advanced care when this begins to take hold. Ice and short rest often don't solve the problem. You need to attack all three problems at once or else you won't be successful. This is why it's going to take much longer for Erik to return than a normal 15 day rest. It often takes 4 weeks or more to calm the area down and strengthen the muscles to provide that stability. The ligaments never heal back to normal without surgery so strengthening the muscles is absolutely key.