MLB Injuries

Matt Shoemaker has a strained forearm, what can you expect?-Dr. Morse

Photographer: Brian Rothmuller/Icon Sportswire

Matt Shoemaker, the RHP for the Los Angeles Angels, was placed on the 10-day disabled list with a strained right forearm. So far this year Shoemaker has pitched half decently, with a 4.52 ERA, 1.30 WHIP, 69 strikeouts over 77.2 innings to go with 6 wins. Shoemaker first started with the Angels in 2013 – only pitching one game, but then pitching very well in 2014 and 2016, sandwiched with a mediocre 2015.

If you remember the end of 2016 season did not go well for Shoemaker, as he was placed on the disabled list on September 5 after he was struck in the head with a line drive.  He subsequently suffered a small skull fracture and hematoma that required emergency late night surgery to stop the bleeding. A very scary situation indeed, but the good news is that he recovered fully and started 2017 off without any residual issues.

Shoemaker suffered a strained right forearm. These injuries typically present with moderate to severe pain, swelling and discoloration, decreased range of motion, and decreased strength. In any athlete that requires the use of their shoulder or elbow frequently, like baseball players and quarterbacks in football, this injury can be very concerning. Hopefully for Shoemaker, it is just simply a forearm strain although the information released has been limited. The concerning thing with this type of injury is its location; as this is a frequent area of injury for baseball players, pitchers specifically, because they require their elbow so much in pitching.

The elbow has two different areas of groups of muscle joining together, the biceps and triceps from above, and the forearm muscles coming from below. In some injuries, the person presents with forearm pain and initially may be diagnosed with a forearm strain. However, forearm injuries can actually be deeper than this, possibly also involving UCL sprain or tear. The Ulnar Collateral Ligament, or the UCL, is the primary stabilizer of the elbow; playing an integral role in most throwing sports, including baseball, football (quarterback), javelin as well as sports like ice hockey and those requiring a racket (tennis). Elbow injuries in athletes are typically chronic, with persistent pain and instability secondary to repetitive overhead activities. However there are some exceptions to this rule, like an acute elbow dislocation. Understanding the anatomy and biomechanics of the elbow is vital to providing the correct diagnosis, and leading to a best treatment course. Click the link below to learn more about UCL injuries:

UCL Injuries

Differentiating between a forearm, UCL and biceps or triceps injury can sometimes be quite challenging. Physicians and physical therapists often have to perform a series of physical tests, stressing the muscles of the upper and lower arm as well as the elbow to determine the correct origin of the pain. If the diagnosis is unclear despite a physical examination by a qualified medicinal professional, then sometimes imaging, often a combination between X-Rays, ultrasound, CT, and MRI, is required to provide a clearer diagnosis. Let’s take a deeper look at the muscles of the forearm.

There are 6 different muscles of the forearm ranging from the elbow to the fingers. Namely these are the: brachioradialis, extensor carpi radialis longus and brevis, extensor digitorum, extensor digiti minimi, extensor carpi ulnaris, and the anconeus. Out of these, the two most commonly injured are the brachioradialis and the extensor carpi radialis longus and brevis. With the palm facing upward, the muscles commonly injured are called the forearm flexor muscles, which are located near the (bottom part of the) elbow. Whereas with the palm facing downward, the muscles most commonly injured are called the forearm extensor muscles, which are located near the (top part of the) elbow.

Similar to the majority of muscle injuries, forearm strains come in three different grades. Grade one is the mildest, presenting with a slight tear in the muscle fibers and minimal to no loss of strength. These often take 2-4 weeks to heal. A grade two forearm strain is the one that most people seek medical attention for. There is a greater amount of bruising than grade one’s, along with a larger area of tearing of the muscle fibers. Grade 2 forearm strains often take 3 to 6 weeks to recover from, sometimes even requiring a PRP (platelet rich plasma) injection to help speed up the process. Grade 3 forearm strains consist of a complete tear of the muscle or tendon. These are the most severe, and thankfully the least common as well. These injuries require immobilization with a cast, sometimes a PRP injection, and often surgery. Due to the severity of grade three forearm strains, these take anywhere from 3 to 6 months to heal.

In addition to the famous RICE (Rest, Ice, Compression, Elevation) principle, cross-friction massage, and physical therapy are often utilized to help rehabilitate the injury. Physical therapy often plays a very important role in the recovery of these injuries, helping to boost the healing process, strengthen the muscles, improves the ROM, and helps to correct any incorrect movements (possibly those leading to the injury in the first place).

Very little information has been released about Shoemaker’s injury besides the fact that he was placed on the 10-day disabled list with a strained right forearm. If the Angels’ medical staff was concerned about any UCL damage, they would likely get an MRI to further evaluate. So far there has been no mention of any imaging of either his forearm or his elbow, which should be taken as good news. Assuming that Shoemaker is dealing with a grade one forearm strain, expect him to return to the mound in 2-4 weeks, which would have him returning in early to mid-July. I hope this was helpful! Stay tuned on @TheFantasyDRs for further information about Shoemaker’s injury.

This was written for the @TheFantasyDRS by Dr. Jesse Morse. I am a Family Medicine trained physician, and I will be beginning a Sports Medicine Fellowship at the University of South Florida in Tampa soon. If you have any questions or comments, you can contact me directly at @DrJesseMorse or visit my website at: www.DrJesseMorse.com Stay tuned for the next article!




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