Baseball and softball are back! I can’t believe that it is baseball and softball season already. Although the MLB might be in a lockout, our local teams in Manhattan Beach and Torrance, Burbank, La Cañada, La Crescenta, Pasadena and all over Los Angeles are just getting started. With baseball skills evaluations complete and practices upcoming, I thought this month’s update should focus on overuse injuries in the young thrower.
Recently, increased attention and awareness has been brought to the issue of overuse injuries to the shoulder and elbow in our young baseball and softball players. Rules on pitch counts, inning limits, days of rest and types of pitches thrown have helped to curb the epidemic, but issues remain.
Shoulder and elbow injuries in the young overhead athlete can be divided into those sustained by skeletally mature or skeletally immature athletes. On average, girls become skeletally mature around age 14 and boys around age 16. In the skeletally mature athlete, injuries occur to the soft tissues, i.e. tendons and ligaments, more commonly. In the skeletally immature athlete, injuries occur to the growth plate (or physis in medical jargon). Injury to these structures is due to overuse. Too much throwing with too little rest.
Elbow injuries most commonly occur on the medial or inside part of the elbow. You may have heard about Tommy John surgery. This was developed by one of my mentors Dr. Frank Jobe. It is done to reconstruct the ulnar collateral ligament. This ligament connects the arm bone (humerus) to one of the forearm bones (ulna) on the medial side of the elbow. It is stretched during throwing. The throwing motion puts super-physiologic loads across the ligament and in time it can fail. The growth plate is at risk for injury in the same area in our younger throwers, this is called little league elbow. Treatment for a complete tear of the ligament requires surgery while little league elbow can be treated with rest and anti-inflammatories.
Similarly, skeletally immature athletes can injure the growth plate in the shoulder. Skeletally mature athletes can injure the rotator cuff or the labrum. A tear at the top of the labrum is called a SLAP tear and is caused by the repetitive throwing motion.
For more details on these injuries, please visit our website. For rules on pitching limitations for young throwers, visit https://www.sportsmed.org/aossmimis/stop/downloads/baseball.pdf.
Have a great season!