Rate of Return to Elite Baseball Pitching Following Shoulder Surgery

There are many different reasons why elite baseball pitchers may need shoulder surgery. But the biggest question is always, How long will it be before I can go back to pitching? Some answers can be found in this systematic review.

Surgeons from the Division of Sports Medicine (Department of Orthopedic Surgery) at Rush Medical College in Chicago, Illinois searched several electronic data sources for studies that might address this question. They found six that qualified with a total of 287 elite pitchers.

All were men, most were professional athletes, and all had reparative or reconstructive shoulder surgery. Almost all of the pitchers (99 per cent) injured their dominant (pitching) arm. And many had more than one shoulder injury requiring surgical correction. Injuries included rotator cuff tears, impingement, joint laxity, joint degeneration, labral tears, and internal impingement.

The authors were interested in establishing the rate of return to sports participation among these elite baseball pitchers after surgery. They found that 68 per cent of the players were able to get back into action (pitching competitively) approximately 12 months after surgery.

Some players were able to return to pitching within nine months after the surgery. Others were not ready for a year and a half (18 months). Very few actually made it back to sports participation the same year they had the surgery. This was especially true for those who had rotator cuff or labral surgery.

If 68 per cent were able to return to pitching, what happened to the other pitchers? Twenty-two per cent (22%) never made it back and ended up retiring from professional baseball. Those who returned to pitching reported some noticeable differences from before their injuries. For example, they pitched far fewer innings post-operatively compared with pre-injury. Certainly, the successful group was able to pitch more than they could after the injury or just prior to surgery.

What was important to the players was pitch accuracy, speed, and endurance. Follow-up over the next three and a half years showed a gradual, continued improvement in all areas of performance (e.g., strikeouts, walks, hits per inning pitched). Complaints reported by pitchers included early fatigue (compared to pre-injury status) and a sense of loss over pitch control. Measurements taken did show a slight decline in maximum pitch velocity (from 94.2 miles per hour to 90.1 miles per hour).

The authors were unable to show comparisons based on the different types of shoulder surgery. The best they could do was suggest that there isn’t a significant difference in results or outcomes between the different problems operated on. There were just too many different tools used to measure performance to compare directly.

In conclusion, overhead throwing (i.e., pitching) requires a fine balance between movement (mobility) and stability. Obviously, not everyone who wants to pitch professionally makes it to the elite level required for professional sports. The years of training and repetitive number of pitches to get to that level can take a toll on the athlete.

With only slightly more than two-thirds of the pitchers returning to play following shoulder surgery (and very few during the same season), every effort to rehab with a conservative approach is advised. Overhead throwing athletes must be advised that surgery may not result in a full return-to-play. And they should be told that if they are able to return to pitching, they may not reach pre-injury levels of pitching.