Conservative treatment throws baseball best playing chance

By Lynda Williams

For baseball players with superior labral tears, conservative shoulder treatment may offer a better chance of returning to play than surgery, say US researchers.

"Our research showed that nonsurgical treatment of [superior labral] tears was more often successful than surgery, and in position players more frequently than for pitchers," commented David Lintner (Methodist Hospital, Houston, Texas) in a press release.

"We need more research to determine why the nonsurgical treatment was more beneficial to one population than the other, but our findings did illustrate that nonsurgical treatment should be preferred."

Overall, 87% of 23 pitchers returned to play, 65% at the same competition level, after following a nonsurgical algorithm to correct scapular dyskinesia and posterior capsular contracture with internal rotation loss (GIRD), reports the team at the American Orthopaedic Society for Sports Medicine's Annual Meeting in Baltimore, Maryland, USA.

In comparison, 46% of 26 pitchers returned to play after surgery, and only 12% played at the same competition level, say Lintner and co-workers.

The review of 79 patients with persistent shoulder pain limiting baseball performance and magnetic resonance imaging showing superior labral tears also showed that position players were more likely to benefit from conservative than surgical treatment, and to have a higher rate of recovery than pitchers.

All eight position players treated with the nonsurgical algorithm returned to play and 75% returned to play at the same level. The return-to-play rate was just 71% for the 15 position players who underwent surgery, and only 35% returned to the same competition level.

Lintner concluded: "Returning to the same level of competition as before the injury, is almost always difficult for an athlete, and surgery is often thought of as the best avenue. With additional research, orthopaedists are finding different routes to treat some of the most common throwing injuries."

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