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Keyword: shoulder

Guest Post by:
Stephanie Davey
Certified Athletic Trainer
MUSC Health Sports Medicine

It is often said that if you want something to last, you must take care of it. For example, regularly changing the oil in your car, you do not want to continue running dirty oil through your engine or it won’t last, the same can be said for your tires, rotate them or they wear out! The body is no different. Athletes, mainly pitchers and quarterbacks, need to take care of their arms, so their arms will take care of them. So why do athletes assume it’s best to not take care of their bodies? Good question, for whatever reason, high school athletes have a bevy of reasons as to why they are not consistent in keeping up with the routine maintenance of their body. Time, lack of knowledge and resources to complete the maintenance, or a lack of accountability are a few of the reasons why athletes do not keep up with their body maintenance.

A lot of time and resources has been spent researching and alerting of the dangers of overthrowing for a baseball player.  However, it seems that many people neglect the arm of a quarterback.  All the hype is on the overuse of arms in baseball players that lead to Tommy John surgery, but there isn’t a lot of talk about overuse of the quarterback arm, which endures large amounts of stress throughout grueling summer camp practices.

In order to limit the excuses or reasons for poor shoulder health of athletes at our high school, we prepare all of our throwers with a routine known as “Thrower’s Ten Exercise Program”. Our baseball program has incorporated this routine into most of their pitchers’ routines, while our football quarterbacks began working through the program during spring practice when shoulder fatigue and tightness became a problem.

The “Thrower’s Ten Exercise Program” is designed to strengthen and stabilize many of the muscles surrounding the shoulder complex, while also serving as a stretching aide to all throwers. The Thrower’s Ten program can be adapted to fit the needs of each athlete in terms of resistance and weight being utilized. We utilize Jaeger Bands, two and a half pound and five pound dumbbells, and Therabands. While the Thrower’s Ten isn’t a new phenomenon in the arm care research, it is an effective time management piece to improving athlete arm care and it is cost effective.

The Thrower’s Ten and other shoulder strengthening plans should be used to help prevent injury and at the direction of someone familiar with arm care. If you or your athlete already have shoulder pain or an injury, it’s best to consult an orthopedic or sports specialized doctor.

What we have noticed at our school is that our throwing athletes have begun to feel better in their shoulders, enhanced their range of motion, increased their arm endurance, and improved their arm strength. Once a routine is established, the athlete needs minimal supervision to ensure the completion of the exercises.

Get to know your shoulder and elbow orthopaedic team at MUSC Health and stay up to date with shoulder and elbow care and injury prevention here on the team blog.

What’s new for November? Dr. Josef Eichinger recently joined Dr. Richard Friedman as a member of the American Shoulder and Elbow Surgeon (ASES) society, making him the second member in the Charleston area and one of six in the state of South Carolina as a whole. He will also be co-chairing the Arthroscopy Association of North America’s (AANA) fall shoulder course November 10-12, 2016.


AANA seal

The calendar events don’t stop there. Dr. Friedman is preparing to chair the 5th Annual Shoulder Course of the International Congress for Joint Reconstruction November 3-5, 2016. And if that wouldn’t keep him busy enough he was recently appointed to the presidential line for the Association of Bone and Joint Surgeons. With upcoming research projects and an ever-changing orthopaedics field, be sure to look out for future posts from your shoulder and elbow team.



Guest post by:

Emily A. Darr, M.D.
Assistant Professor of Physical Medicine and Rehabilitation
Department of Orthopaedic Surgery

Deanna Roberts, MS ATC
Department of Orthopaedic Surgery

Chances are, you've participated in the great sport of volleyball at a very young age. Whether it was in gym class, on a school team, or just out at the beach having fun with friends, volleyball is one of our country's favorite sports. Volleyball seems like a fairly safe, non-contact, low injury kind of a sport, right? Well, as popular as the sport has become both on the court and in the sand, a fair amount of injuries occur. Although considered a noncontact sport, the rate of injury is surprisingly high. Volleyball skills require quick, forceful movements of the entire body all at once in multiple planes, making injury inevitable. Both knee and shoulder injuries are commonly seen in volleyball players.

The shoulder accounts for 8%-20% of volleyball injuries. The majority of shoulder injuries are related to chronic overuse especially of the rotator cuff. Frequent motions involving high forces at the shoulder in multiple directions during the spiking motion are often the cause of these chronic injuries.  Muscular imbalances appear to be strongly associated with these overuse type injuries so keeping the rotator cuff super strong is very important with special attention given to stretching the shoulder. This can get rather tricky so having a Physical Therapist or Athletic Trainer show you the right way is recommended.

Rotator cuff injuries are caused by repetitive overhead hitting of the ball and/or from underlying joint instability. It can be as mild as a tendonitis or as serious as a complete rotator cuff tear. See a sports medicine specialist if you think you have an injury to your rotator cuff that doesn’t seem to get better. Treatment varies from anti-inflammatories and physical therapy to surgery depending on the severity.

Impingement syndrome occurs when the supraspinatus tendon (one of the rotator cuff muscles) becomes irritated and painful as it passes through a tight space called the subacromial space. Sometimes anatomic variances and/or joint instability from muscular imbalances can contribute to the pinching of this tendon. Painful shoulder motion, in addition to night pain, is a result of these muscular imbalances, overuse and anatomical variances. Surgical intervention may be necessary if conservative therapy fails to allow you to return to play. In some instances a corticosteroid injection is beneficial.

At the knee, you have similar forces coupled with gravity and a twisting, flexing force when you land from that high vertical. The most commonly seen overuse injury in volleyball is patellar tendonitis or jumper’s knee.

Patellar tendonitis, better known as jumper's knee, is an overuse injury that results in inflammation of the patellar tendon. In volleyball, this occurs as repetitive jumping places stress on the patellar tendon in an effort to straighten the knee. In most cases, patellar tendonitis will resolve with rest, activity modification, ice, anti-inflammatories and strengthening of the supporting muscle groups in the thigh, hip and buttocks. However, repetitive jumping without rest or treatment can lead to further injury of the tendon including rupture, which can require surgery.

Anterior cruciate ligament (ACL) injuries, although not as common in volleyball as patellar tendonitis, can occur as a result of an awkward or improper landing, or when performing a cutting or twisting movement. The ACL functions to prevent the tibia from sliding forward on the femur bone and provides rotational stability for the knee. The repetitive cutting, jumping and rotational movements involved in volleyball place players at an increased risk of ACL injuries. Depending on the severity of injury to the ACL, surgery and a lengthy rehabilitation program are considerations for most athletes. Due to the increasing number of ACL injuries occurring in the sport, many athletes are being trained with a focus on proper body mechanics and control, as well as safe landing and deceleration techniques.

Also keep in mind that some volleyball injuries are common to specific surfaces because volleyball is played on a variety of surfaces, such as wood, grass, concrete, and the increasingly popular sand!

Briner et al. Sports Med. 1997;24(1):65-71.

Dr. Harris Slone

Guest Post by:

Harris S. Slone, MD
Assistant Professor
Department of Orthopaedics - Sports Medicine
Medical University of South Carolina

Each year up to 6 million children and adolescents participate in organized youth baseball, and up to 14 million may play some form of recreational or unorganized baseball.1 During this time of year, many of our youngsters here in Charleston will dust off the cleats, pull the glove out of the closet, and hit the baseball diamond.  Youth baseball is a great sport, which helps teach our rising superstars teamwork, discipline, and helps keep them fit and active.  

In general, youth baseball is a very safe sport.   It is estimated that between 2-8% of youth baseball players sustain some sort of injury each year.1  Serious injuries are uncommon however, and generally are acute injuries from direct player-to-player contact, bat-to-player contact, and ball-to-player contact injuries.  Efforts to minimize serious injuries have been employed, including the use of specialized protective equipment, softer and lighter baseballs, rule modifications, elimination of “on-deck” areas, and dugout screening.

In contrast to acute and serious injuries, which are relatively uncommon, overuse injuries of the shoulder and elbow are very common in little leaguers.  Pitchers are most susceptible to overuse injuries of the shoulder an elbow, given the repetitive stress of repeated pitches.  Younger (skeletally immature) patients are at a higher risk of repetitive use injuries, compared to older players.

Experts in orthopaedic surgery have extensively researched youth baseball shoulder and elbow injuries to identify risk factors, and prevent future injuries, and guidelines have been published to minimize risks of injury. Studies have shown that pitch type, pitch count, number of innings pitched, and other positions played may influence a players injury risk. 

Current recommendations include avoiding pitching for two teams during the same season or overlapping seasons, or playing pitcher and catcher in the same game.  Players should avoid overhead throwing for at least 2 months per year, and avoid pitching for at least 4 months per year.  No player should pitch more than 100 innings per year.2 Pitching biomechanics must be established at a young age.  Once players demonstrate good pitching biomechanics, fastballs and change-ups can be introduced.  Curveballs and sliders have been shown to increase the risk of injury in young pitchers.  Most experts agree that curveballs should not be thrown before the age of 14, and sliders should not be thrown before 16. More information and guidelines for pitch counts, and recommended number of rest days between pitching can be found here.  If you or your little leaguer notice any pain in the throwing arm or shoulder, fatigue, or declining pitch velocity, seek professional medical attention from a sports medicine specialist to ensure a long an healthy baseball career.


1.     Matta PA, Myers JB, Sawicki GS. Factors Influencing Ball-Player Impact Probability in Youth Baseball. Sports Health: A Multidisciplinary Approach. 2015;7(2):154–160.

2.     Fleisig GS, Andrews JR. Prevention of elbow injuries in youth baseball pitchers. Sports Health. 2012;4(5):419–424.




Dr. Harris S. Slone is an orthopaedic surgeon specializing in sports-related injuries, such as injuries to the ACL, ankle, knee, and shoulder. He also treats ankle instability, rotator cuff disorders, and shoulder instability. He completed a fellowship in Sports Medicine and Arthroscopy at Emory University following his residency in orthopaedic surgery at the Medical University of South Carolina. During his fellowship, Dr. Slone was a team physician for the Atlanta Falcons and the Georgia Tech Yellow Jackets. He is accepting new patients 10 years of age and older at MUSC Health locations in West Ashley, Mount Pleasant, and North Charleston.



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