Carlos Rodon, the starting pitcher for the Chicago White Sox, 24-year-old 6’3″ lefty has yet to make his season debut due to biceps tendinitis that has kept him on the disabled list all year. The good news is that Rodon is scheduled to make his next rehab start tomorrow with AAA. He has only made one rehab start so far, which did not turn out as good as expected, but at least he’s healthy. The former number three pick of the 2014 draft, has significant future potential, with FanGraphs rating several of his pitches above-average, giving him a future value of 65. Let’s look a little further into the exact injury that caused Rodon to be sidelined.
Rodon was diagnosed with biceps tendinitis, which is the inflammation of the tendon around the long head of the biceps muscle. This is not to be confused with biceps tendonosis, which is often caused by the degeneration of the tendon from repetitive athletics that require overhead motion, but sometimes the normal aging process can also cause this. For simplification purposes, just consider tendonosis as a chronic injury, and tendinitis an acute injury. The inflammation of this bicep tendon is located in the bicipital groove (known as the primary biceps tendinitis), but this is quite uncommon – only occurring in about 5% of patients with biceps tendinitis. Biceps tendinitis and tendonosis are commonly accompanied by rotator cuff tears, or SLAP (superior labrum anterior to posterior) lesions.
Patient with biceps tendinitis or tendinosis usually complain of a deep, and throbbing ache in the front part of their shoulder. Repetitive overhand motion of the arm, such in a baseball player or particularly a pitcher, are notorious for causing this injury and lead to exacerbation of the symptoms. Pitchers often feel this pain when they entering the follow-through phase of their throwing motion. Other sports that often lead to this injury include contact sports, swimming, gymnastics and martial arts. Primary impingement in athletes older than 35 years old, often leads to a higher incidence of rotator cuff tears than in younger athletes. The most common finding and biceps tendinitis is bicipital groove point tenderness, especially when the arm is rotated 10° internally, and is often worse at night. This pain may also be accompanied by some pain radiating down to the hand – which further makes this disease difficult to distinguish between a rotator cuff injury as well as cervical disc disease.
How do we typically treat biceps tendinitis? Local corticosteroid injections into the biceps tendon sheath can both be therapeutic as well as diagnostic. The exact location of the ejection has to be very specific and the physician has to make sure that the corticosteroid its not injected directly into the biceps tendon sheath because this will increase the risk of rupture. Often these injections are done using ultrasound to guide the needle into the exact location, which leads to a 5x increase in analgesic effect.
The best initial radiographic study to evaluate the shoulder is an x-ray to rule out impingement. Once ruled out, then ultrasound should be used to visualize the biceps tendon. If the patient does indeed require surgery, many surgeons will prefer obtaining an MRA or CT-A to help further visualize the intra-articular tendon as well as any related issues.
Initially conservative treatment of biceps tendinitis includes the classic RICE formula, which includes rest, ice, oral analgesics (NSAIDs), physical therapy and sometimes corticosteroid injections into the biceps tendon sheath. A throwing program may need to be started to ensure that the rotator cuff, the scapula rotators, and what is called the prime humeral movers (pec major, lat dorsi and deltoid) are all strong enough. My suspicion is that the reason why it took so long for Rodon to return is because this throwing program needed to be started from scratch after he was healthy to start throwing again. If there is severe damage to the biceps tendon, and the patient has failed conservative measures over a three-month period, then often surgery is required.
The good news is that it sounds like Rodon is currently on his way back from rehabbing this biceps tendinitis and he is expected to make his debut likely in the next 7 to 10 days. Once Rodon gets back into his groove, expect about one strikeout per inning with a ERA between 3.00-4.00. I would recommend picking him up or trying to get him for cheap as he has the potential to lead a young White Sox pitching staff with loads of potential.
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 next month. If you have any questions or comments, you can contact me directly at @DrJesseMorse.