More baseball players return to pre-injury levels after elbow vs. shoulder surgery

Investigators discovered that 45% of pro athletes re-entered the same or higher playing level.

Issue: May 2008

AOSSM

SAN FRANCISCO — Investigators found that more professional baseball players return to the same or higher playing level after elbow surgery than they do following shoulder procedures and that higher-level players tend to not reach their pre-injury performance levels than do some minor league players.

In a retrospective review, Steven B. Cohen, MD, and colleagues studied the records of 44 professional baseball players who underwent surgery for shoulder or elbow injuries and assessed their return to baseball. The investigators discovered that 45% of the all professional baseball players, including A-level minor league players, returned to the same or higher level of professional baseball after surgery and found that 52% of players having elbow surgery returned to that level compared to 35% who had shoulder surgery.

Single-club experience

The study also revealed that 39% of players retired after surgery and that only 22% of upper-level professional, including major league and AAA and AA minor league, players were able to return to their pre-injury levels.

“Return may not be as high as we once thought, particularly for shoulder injury, despite experienced treatment,” Cohen said during his presentation at the American Orthopaedic Society for Sports Medicine Specialty Day Meeting, here. Surgeries were performed by multiple, experienced surgeons both inside and outside of the organization.

Cohen and his colleagues reviewed the records of AAA, AA, A and major league baseball players in one professional club during a four-season period from 2003 to 2006. The study included 26 players who underwent shoulder surgery (28 procedures) and 21 players who had elbow surgery (23 procedures). Three players underwent both procedures. There were 19 pitchers in the shoulder group and 20 in the elbow group.

High level, less return

Surgeons performed 23 labral repairs, a labral debridement, a rotator cuff repair, a rotator cuff debridement, a capsular release and an acromioplasty in the shoulder group. Of the 26 players in the group, nine returned to the same or higher playing level after surgery.

“At the high professional level — major league baseball, the AAA and AA level — only one of 12 players was able to return to that high level,” Cohen said. Of the patients who had labral repairs, 10 retired from baseball after surgery, six returned to the same or higher playing level, five went to a lower level and one remains in rehab.

In the elbow group, 12 players underwent ulnar collateral ligament reconstructions, seven underwent loose body excision, three had ulnar nerve transpositions, and one had a flexor debridement. Overall, investigators found that 11 of 21 players returned to the same or higher playing level after surgery.

“[At] the high professional level, only four of 12 players who started at that level were able to return to the same or higher level,” Cohen said. “Looking specifically at ulnar collateral ligament reconstructions, six of the 12 players were able to return to the same or higher level, four players left baseball and there’s still one player who is undergoing rehabilitation.” Of the pitchers in the group, 15 returned to the same or higher playing level, 12 retired after their injury and six played at a lower level.

Most of the baseball players’shoulder injuries occurred in the labrum
The investigators found that most of the baseball players’ shoulder injuries occurred in the labrum.

Half of the patients who underwent ulnar collateral ligament reconstructions returned to the same of higher level of play, four retired and one is in rehabilitation.

Of the patients who had a labral repair, 10 retired after surgery, six returned to the same or higher playing level, five went to a lower playing level and one remains in rehabilitation.

Images: Cohen SB

For more information:

Steven B. Cohen, MD, director of sports medicine research at Rothman Institute Orthopaedics, can be reached at 925 Chestnut St., Philadelphia, PA 19107; 434-825-6232; e-mail: steven.cohen@rothmaninstitute.com. He has no direct financial interest in any product or company mentioned in this article.

Reference:

Cohen SB, Sheridan S, Ciccotti MG. Return to sports for professional baseball players after surgery of the shoulder or elbow. Presented at the American Orthopaedic Society for Sports Medicine Specialty Day Meeting. March 8, 2008. San Francisco.