Shoulder Injuries, or the Story of Scott Rolen

Just look at the leverage generated by the unnatural shoulder supination in the cocking phase here! I hope this is not how Masset injured himself... (Photo by Jared Wickerham/Getty Images)

If you play(ed) baseball into your late teens or beyond, I'd wager you have experienced shoulder discomfort, if not an outright injury. Shoulder problems are baseball-centric. Seeing that the Reds (and the Bats) currently have four players sidelined with shoulder injuries, I thought it would be a good time to take a look at these injuries in more detail. I've also been researching shoulder injuries on my own recently because my own baseball playing days were ended prematurely (but not that prematurely to be honest) by a debilitating shoulder injury. As it happens, my wife started working as an orthopedic specialist just over a month ago and I took the liberty of reading some of the research/trade journals she keeps lying around the house these days, and wouldn't you know, shoulder injuries were recently highlighted.

The shoulder is the origination point for a lot of moving parts that are involved in throwing a baseball, and is also the fulcrum of the throwing motion. The shoulder is also one of the most unstable joints in the body, and has the widest range of motion. As such, there are a lot of distinct injuries that can arise in the shoulder for baseball players. Often these injuries overlap, and discerning one specific injury from another can be difficult even for orthopedic doctors and with diagnostic equipment (arthroscopy is the only method that gets even close to 100% for diagnosing shoulder injuries). So with the general explanations that are given by MLB teams about player injuries, I am going to do my best to determine what is probably wrong. With that in mind, let's take a look at the injured players and what we might expect as far as having them back on the field.

Brett Tomko: Tomko went on the DL May 31 with shoulder tendinitis. That is about as vague as shoulder injuries can get. It could refer specifically to inflammation of the biceps tendon (which anchors at the shoulder) or the rotator cuff, but tendinitis is also commonly the description given for other injuries such as labrum tears, impingement, scapula injuries, or ligament damage, at least initially, before it becomes clear that the soreness/pain is being caused by something more severe. If the problem is tendinitis, rest, ice, and anti-inflammatories should suffice and Tomko could return in as little as a week, depending on the severity. If this injury turns out to be something more serious like a tear, rehab would be closer to a month at least, or surgery could be needed.

Denis Phipps: Phipps' injury is unusual in baseball because it is not a result of overuse, but a singular traumatic event (landing on the shoulder). This is most likely good news, because it is unlikely that anything was torn. Even if the shoulder were separated by the impact, that injury is usually not as bad as it sounds, as the shoulder joint naturally is loose and allows for a lot of motion within the joint. As long as Phipps does not land awkwardly on the shoulder again, it should not present problems for baseball activities, unless there is a muscle or cartilage tear. For shoulder dislocations, rehab begins almost immediately, and can last up to two months (though probably faster for a pro athlete). If nothing was torn, I think Phipps should probably return in the next two weeks. He will have to be careful though, because shoulder separations can become a repetitive injury due to the weakening/stretching of the muscles and cartilage that stabilize the shoulder socket.

Nick Masset: Nick Masset's injury was also officially labeled shoulder tendinitis. However, at this point I have to imagine it something more severe since he's been out over two months (since March 26) and has just begun throwing. To me, this looks like a timetable for rehabbing a SLAP injury - a labrum tear. If this is true, it could be another month or two before Masset can return, if it doesn't require surgery to fix. Rotator cuff injuries usually require surgery, so that is probably not the case. It is also possible that Masset has impingement. All these injuries are often concurrent, as one can be a cause of the next, and they are simply interrelated. The timetable for rehab is approximately the same for each/all. Because Masset has already been out for this long, and the Reds are not opting for surgery, it's possible (though pretty unlikely) that Masset is trying to rehab quadrilateral space syndrome. Again, it would probably be another month of rehab for that injury. So unless this really is a just severe case of tendinitis, I'd look for Masset to return around the All-Star break.

Scott Rolen: As I mentioned in the last injury update, Rolen has had four shoulder surgeries to date. The only good news is that his injury is on his non-throwing shoulder. It appears the problems started because of a collision with Hee-Sop Choi, which resulted in a labrum tear. He opted for surgery in 2005. He continued having problems in 2006 and had another surgery to remove scar tissue and the bursa itself which was causing problems consistently. Last year, Rolen had arthroscopic surgery to remove bone spurs from the shoulder (probably a result of having removed the bursa).

The left shoulder has been a chronic problem for Rolen over the past two years now, and I don't see how the condition is going to really get any better. Rest and anti-inflammatory medications will allow the inflammation to subside, but once he begins to stress the shoulder again, the symptoms are sure to resume. He could have a cortisone injection and try for one last push this season, but I just don't see the benefit for Rolen to risk further injury in that way, nor for the Reds to pressure him into that. I doubt Rolen will have another surgery (and I am not sure what procedure could even be done at this point unless he has torn another muscle or tendon, and if he's done that, he won't be able to return this season anyway). The shoulder is very clearly affecting his performance in a negative way, as his production has seen a steady decline since the second half of 2010.

Rolen could come back and play a few dozen more games for the Reds, but if his performance remains what it's been in the last two seasons I am not sure it's worth it for either party. As I said before, this could unfortunately be the end of a great (even HOF-worthy) career. In a way it reminds me of Jeff Bagwell's deteriorating arthritic shoulder condition. Sometimes players are pushed out of the game too early because of untreatable injuries.

It's my personal opinion that shoulder injuries are the worst type for baseball players to get. They are difficult to diagnose accurately, require tedious and lengthy rehab, are difficult to repair, easily become chronic, and for pitchers especially can be devastating in their affect on performance even after rehab/repair. It's an unstable joint, and baseball exposes it to extreme stress as a requirement. I hope these four guys can come back healthy and effective, and lucky for them, they have the best doctors and trainers to see them through.

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