Slap lesions in pitchers
In this article Ross Hauser, MD. will discuss research concerning return to play in major league baseball pitchers undergoing surgical and non-surgical repair for SLAP lesions.
Doctors at Houston Methodist Hospital published these findings in the American Journal of Sports Medicine:
The published return-to-play (RTP) rates for athletes who have undergone surgical repair of superior labrum anterior-posterior (SLAP) tears vary widely and are generally accepted to be lower in the group of competitive throwers (baseball pitchers). Therefore the effectiveness of nonsurgical treatment should be explored.
- Before you read on, if you have questions about slap lesions of the shoulder, send them in by emailing us
The Houston group looked at 119 patients in a single professional baseball organization with persistent shoulder pain that limited the ability to compete.
- Sixty-eight patients had magnetic resonance imaging-documented SLAP lesions.
- All patients had failed 1 attempt at rehabilitation but had continued with supervised physical therapy.
- Treatment was according to an algorithm focusing on the correction of scapular dyskinesia and posterior capsular contracture with glenohumeral internal rotation deficit (GIRD), followed by pain-free return to throwing.
- Scapular dyskinesis or SICK scapula syndrome is considered an overuse injury (common in throwing athletes) in which there is abnormal movement and resting location of the scapula.
- Posterior capsular contracture with glenohumeral internal rotation deficit (GIRD) also dignify abnormal movement of the shoulder with overuse being a possible cause.
Those who failed 2 cycles of nonsurgical treatment were treated surgically.
Success was defined by 2 different standards:
(1) return-to-play (RTP), success was measured in accordance with previous study findings; and
(2) a more stringent standard of return to the same level/quality of professional competition (level A baseball, Double A baseball, Triple A baseball etc.) with the incorporation of a return to preinjury individual performance statistics (earned run average, walks plus hits per inning pitched), termed “return to prior performance” (RPP).
- Sixty-eight athletes were identified with SLAP lesions.
- Twenty-one pitchers successfully completed the nonsurgical algorithm and attempted a return.
- Their return-to-play rate was 40%,
and their return to prior performance rate was 22%.
- Their return-to-play rate was 40%,
- The return-to-play rate for 27 pitchers who underwent 30 surgical procedures was 48%, and the RPP rate was 7%.
- For 10 position players treated nonsurgically, the return-to-play rate rate was 39%, and the RPP rate was 26%.
- The return-to-play rate for 13 position players who underwent 15 procedures was 85%, with an RPP rate of 54%.
- Nonsurgical treatment correcting scapular dyskinesia and GIRD had a reasonable success rate in professional baseball players with painful shoulders and documented SLAP lesions.
- The rate of return after surgical treatment of SLAP lesions was low for pitchers.
- The return-to-play rate and RPP rates were higher for position players than for pitchers.
- Nonsurgical treatment should be considered for professional baseball players with documented SLAP lesions, as it can lead to acceptable return-to-play rate and return to prior performance rates.1
Non-surgical injection therapy for SLAP lesions
In a study from late 2016, doctors at Wayne State University School of Medicine published these findings:
- Of the twenty-four Major League Baseball players who had SLAP tear surgical repair between 2003 and 2010 who met the study criteria:
- 62.5% were able to return-to-play at the Major League level after SLAP repair surgery.
- Of those able to return-to-play, 86.7% were able to return to prior performance.
However, the overall rate of return to prior performance, including those unable to return-to-play rate, was 54.2%. A little more than half had a successful surgery and return to prior performance. However performance analysis of the return-to-play group revealed a statistically significant decrease in innings pitched for Major League pitchers throwing a mean 101.8 innings before injury and 65.53 innings after injury.2
If you would like to discuss non-surgical options for your SLAP lesion problems – talk to our specialists.
- Ross Hauser, MD | Danielle Steilen-Matias, PA-C | Katherine Worsnick, PA-C | David Woznica, MD
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1 Fedoriw WW, Ramkumar P, McCulloch PC, Lintner DM. Return to play after treatment of superior labral tears in professional baseball players. Am J Sports Med. 2014 May;42(5):1155-60. [Pubmed]
2 Smith R, Lombardo DJ, Petersen-Fitts GR, et al. Return to Play and Prior Performance in Major League Baseball Pitchers After Repair of Superior Labral Anterior-Posterior Tears. Orthopaedic Journal of Sports Medicine. 2016;4(12):2325967116675822. [Pubmed]