Our 20-year old son is on a baseball scholarship to college. He is one of several pitchers they use, but he's not the main pitcher. During training he was told he had a problem that could become serious and was given a bunch of stretches to do. What happens if these don't work?

Shoulder problems are very common among baseball pitchers and other overhand throwing athletes. The pitching or throwing motion puts torsional overload on the fibers of the rotator cuff with actions repeated over and over.

Since the fibers of the tendons attach around the joint and to the bone, repetitive motion can also affect these areas. Shear force of the tendons can actually cause the tendon to tear or rupture. Sometimes a piece of the joint cartilage or bone comes off too.

These are the kinds of injuries pitchers try to avoid. Early screening during training is very helpful to identify any problems such as a loss of motion, joint tightness, or loss of flexibility. Sometimes too much motion can cause shoulder joint instability.

Stretching and strengthening are usually the first steps in a conservative plan of treatment. If these don't work, then surgery may be needed. For example, if the tissue around the shoulder is too tight, one or more incisions may be made to release the joint capsule. Intensive physical therapy is needed afterwards to maintain the motion.