Josef Karl Eichinger M.D.Professor of Orthopedics

Board-certified Sports Medicine, Shoulder & Elbow Orthopedic Surgeon

Board-certified Orthopedic Surgeon

Specialist in Total Joint Replacement Surgery of Shoulder & Elbow

Professor, Orthopedic Surgery, Charleston, South Carolina

Former Chief, Orthopedic Surgery, Madigan Army Medical Center, Tacoma, Washington

Former Chief, Orthopedic Surgery, Womack Army Medical Center, Fort Bragg

Named to the Arthroscopy Association of North America (AANA) Education Committee for a 2 year term starting in 2019.

Expert in Sports Injuries, Shoulder and Elbow Instability

Pitching Pain

Numerous parts of the shoulder are utilized and strained while throwing: the rotator cuff, the glenoid, the ligaments, the labrum, and the biceps. The biomechanics of pitching or throwing has roughly 6 stages, all of which impact the arm in a different way, and may result in pain or injury following overuse.

Stage	Description	Injury Potential
Wind up	Storage of energy Center of gravity is over the back of the leg Rotation of the upper trunk Begins with the movement of the back leg and completes with the elevation of the lead leg and separation of glove and ball	Rarely a cause of injury
Early Cocking	Begins with the lead leg at max height, ends with the lead foot contacting back with theground Torso and pelvis rotate in opposite directions Transfer of the energy of the lower body into the upper extremity	Shoulder stiffness can result in over and under trunk rotation, creating back or hip pain
Late Cocking	Begins with the lead foot contacting back with the ground and ends with the point of maximal external rotation Maximum valgus torque generated: 64 Nm Equivalent to 40lb of weight in the hand	Pain during this stage of throwing is frequently related to problems with the ulnar collateral ligament (UCL) or an anterior labral tear
Acceleration Phase	Between maximum external rotation and ball release Rotation from 175 degrees of external rotation to 100 degrees of internal rotation in 42-58 milliseconds Rotational velocity of 7000-9000 degrees per second	UCL pain typically present during this phase Pain may also result from early arthritis in the back of the elbow
Deceleration Phase	Between ball release and maximum humeral internal rotation and elbow extension Most violent phase of throwing cycle Maximum joint loading Posterior shoulder muscle and biceps/brachialis activity is decelerating the shoulder and elbow	SLAP tears and posterior labral tears are problematic during this phase
Follow-Through	Body continues to move forward Ends with the player in the fielding position	Unlikely culprit of injury