Dylan Bundy injury: Orioles prospect's shoulder problem should be OK long term

Is anyone else here getting tired of this? I mean how many times can an Orioles pitching prospect have something stunt their development? I could be wrong here (I am), but I'm pretty sure that Murphy's law of anything that can go wrong will go wrong, was specifically written about Orioles pitching prospects.

Ok, now that I am done venting about the plight of Orioles pitching prospects, I guess I'll get started with talking about Dylan Bundy's shoulder

The injury: R rotator cuff calcific tendinitis

Expected recovery time: Unknown

What is the rotator cuff and what is its role?

The rotator cuff is a group of four small muscles that primarily help to stabilize the shoulder joint during movements. Specifically, the rotator cuff muscles help to hold the head of the humerus (ball) in the glenoid fossa (socket). When a pitcher or player throws a baseball, the forces forces from the larger shoulder muscles act to pull the head of the humerus (ball) out of the glenoid fossa (socket). However, even though the rotator cuff muscles are relatively quite small, when they are intact and working effectively, they are able to stabilize the ball in the socket and prevent excessive movement in the shoulder joint.

Ok, so I've heard about "tendinitis" before, but what's the deal with this calcium buildup?

Before we jump into the progression and rehab of the condition, I think it's important to just go over the difference between tendinitis and clacific tendinitis (what Bundy has). Tendinitis is literally defined as the inflammation of a tendon and generally occurs as a result repetitive use of certain tendon. Calcific tendinitis is still inflammation of a tendon, but now, the tendon also has a build up of calcium minerals.

I'm sure you all are probably wondering why the calcium deposits showed up in Dylan Bundy's rotator cuff. Well, if you were wondering this, I have some good news and some bad news for you. I feel like I'm a positive guy so I'll start you off with the good news: It seems like other people that are smarter than me have looked into this issue and also want to know the answer to that question. And now for the bad news: they aren't exactly quite sure why it happens. With that said, it appears that Bundy may have been given a possible reason for how the calcification developed.

"The best guess, Bundy said, is that he strained a shoulder muscle and the bleeding from that produced calcium, and the calcification caused the soreness and, subsequently, affected his range of motion."

How come no one is giving a timetable for Bundy's return?

Well, for starters, there's just no way to how long it will take for the calcium deposits to disappear. Obviously, that's not the most satisfying answer to hear as a fan, but the most important thing to consider here is that the calcium deposits WILL disappear. In general, the type of calcific tendinitis that Bundy has will follow three stages: pre-calcific stage, calcific stage, and the post-calcific stage.

Currently, it appears as if Bundy is in the second stage the of injury since the MRI showed the presence of calcium deposits. During this stage, some of the common symptoms include pain with movement and decreased range of motion. Towards the end of the calcific stage, the calcium begins being reabsorbed into the body which will actually cause increased pain in the shoulder. Once the calcium deposits are no longer embedded in the tendon, the final, post-calcific stage, begins. From a rehab standpoint, once the patient enters the final stage is when we can begin more aggressively trying to regain range of motion and strength in the shoulder.

What are some keys to rehab following this type of injury?

To answer this question I figured I had a few options. My first option would be to use the knowledge I have gained from school and combine that with information I gathered from the internet to make a well educated guess. My second, and far better option, would be to reach out to someone who has much more experience than I do with rehabbing these types of injuries. Lucky for us, Dr. Yoni Rosenblatt of True Sports Physical Therapy in downtown Baltimore was willing to make my job here easier and provide a few keys to rehab for calcific tendinitis. Currently, Dr. Rosenblatt serves as the chief physical therapist for the Israeli National Lacrosse team and provides sports specific rehabilitation for Morgan State's student athletes.

"One of the things that I will work to emphasize throughout rehab will be ensuring that core and lower body strength are maintained. Although the athlete is coming in for a specific shoulder injury, incorporating core and lower body work into our programs is essential for getting the athlete back to 100%. In terms of Bundy's shoulder injury, some of the key things I look to achieve through rehab are trying to equalize strength in the shoulder rotators, increasing general rotator cuff strength, and improving eccentric control of the cuff."

For those of you who aren't gym rats or physical therapists/physical therapy students, a good example of eccentric control of movement at the shoulder would be a follow through motion of a pitch or a throw.

Once Bundy completes rehab is there any reason to think he won't be able to pitch at a high level?

From a shoulder health perspective (assuming this is the only thing going in his shoulder) there is no reason to believe Bundy won't be able to pitch in the big leagues again.

As always, I hope this helped to provide a little bit information into Bundy's injury and rehab and if you have any more questions feel free to leave a comment or tweet it to @Dschwartz_PTs

- David Schwartz PT/s, CSCS