Coming off a World Series appearance and currently sitting at 15-19 in the early parts of the 2018 season, the Los Angeles Dodgers placed their ace pitcher, Clayton Kershaw, on the disabled list with left biceps tendonitis.
Clayton Kershaw’s MRI results confirmed biceps tendinitis. He will begin his rehab in Los Angeles tomorrow.
— Los Angeles Dodgers (@Dodgers) May 7, 2018
He has told his manager that he didn’t feel right after his start last Tuesday against Arizona. Given that he doesn’t have to pitch every five games, he was able to get extra rest to see if it would help with his arm.
Roberts said that Kershaw wasn’t feeling right yesterday when playing catch. He never made it to his bullpen session yesterday after cutting short playing catch. #Dodgers
— David Vassegh (@THEREAL_DV) May 6, 2018
But with him returning to Los Angeles to be examined by Dr. Neal ElAttrache it was revealed to being Biceps Tendonitis and nothing more.
Anatomy Review:
There are three muscles that need to be looked at when dealing with the front of the arm. There is the coracobrachialis, the brachialis and the biceps brachii. While the MRI revealed it’s biceps tendonitis, what the report doesn’t say is where he is having pain, but it can be assumed it’s at the proximal insertion site (the shoulder) comparatively to the distal insertion site (the elbow) given the fact that he is a baseball pitcher.
So if we are talking about proximal arm pain, you can look at the biceps brachii tendon or the coracobrachialis tendon. Both muscles insert on different parts of the scapula. We are able to rule out Brachialis involvement because the Brachialis does not cross the shoulder joint and is strictly an elbow flexor. The difference between the coracobrachialis is that it’s an accessory muscle comparatively to being a prime and important muscle in arm and shoulder movement (like the Biceps Brachii).
Coracobrachialis: Assists in shoulder flexion and shoulder adduction
Biceps Brachii: Assists in elbow flexion and shoulder flexion
Biceps Tendonitis:
Commonly stated as an irritation of the Biceps Brachii Long Head muscle tendon at the insertion site at the scapula. The biceps brachii long head tendon can be irritated due to repeated motions in overhead athletes or throwing athletes.
Can often be diagnosed through a variety of orthopedic testing it can progress into a partial tear and potential a complete tear if the proper recovery methods are not taken. Soft tissue injuries are best determined via MRI and not X-ray.
Rehabilitation:
We need to strengthen the Biceps Brachii tendon. But the only focus cannot be on the Biceps because the Biceps influences the rest of the shoulder as well. So strengthening of the scapula and make sure there is proper scapular movement is going to be just as important as strengthening the biceps itself.
While I do enjoy using the exercise, Biceps Curls, for anyone experiencing anterior shoulder pain that I see in the clinic, Clayton Kershaw is going to need more than that, but biceps curls certainly will be part of the treatment.
In terms of the manual component, we’re going to work the entire length of the Biceps Brachii muscle from the elbow all the way to shoulder. We’ll also work the deltoids, pectoralis minor, and corachobrachialis muscles as well.
Then there is other common modalities such as: electrical motor stimulation (which why don’t more athletic training facilities in high school utilize more of), ultrasound, shockwave therapy. But those treatments are more along the lines of reducing inflammation and reducing pain before getting him active in his recovery with the strengthening, stretching, and mobilization components.
My Take:
This is an injury that should not have any lasting effects if handled correct over the next two weeks. While he is “out-of-action” for the next ten days, it is certainly not out of the realm of possibility he could be out several more days to help determine the severity. With his history of injuries (herniated disk, other low back injuries [2016 and 2017]), it doesn’t seem to bode well to rush him back.
I believe it’s possible he may be out for longer than ten days to make sure his biceps tendonitis doesn’t become more severe or create other symptoms that may disrupt his pitching mechanics stressing other joints (wrist and/or elbow). He may make an extended stint on the disabled list (DL) until doctors are certain he can pitch at a high level without pain during and afterwards.
He’s going to be back this season and pitching at a high level, I just don’t believe he should be rushed back given his history of injuries and the fact that his injuries have caused him multiple visits to the disabled list in a season.
