Avoiding Throwing Injuries In Young Athletes
Reed L Bartz, MD
Shoulder and
elbowproblems in
the youth baseball pitcher are common. In fact, a recent study of little leaguers from fifteen youth baseball leagues revealed that approximately fifty percent of players experienced shoulder or elbow pain in a single season. An increased incidence of shoulder and elbow pain was noted in pitchers who threw curveballs and sliders. Although the risk of injury to a pitcher is known to increase with age and level of competition, many pitching injuries requiring medical attention in the more elite level of pitcher are thought to result from cumulative stresses that begin with throwing at the youth level.
The youth thrower is more at risk for stress related injuries, as the growth plates in the shoulder and elbow are open and susceptible to the high rotation forces generated by throwing a baseball. Although upper extremity muscle soreness is normal in the development of a youth pitcher, joint pain (such as in the shoulder and elbow) is not, and should be evaluated by a medical professional.
The term “little leaguer’s elbow” has been used to describe multiple causes of pain in the adolescent thrower’s elbow (including
tendonitis, loose bodies, or osteochondritis dessicans). The adolescent thrower may present with pain during or after throwing, as well as loss of pitch control. Early detection is paramount in the treatment of “little leaguer’s elbow.” If radiographs are normal, conservative treatment with rest, ice and stretching is usually successful. Adolescent pitchers should not be allowed to resume throwing until all symptoms have resolved. If elbow radiographs reveal degenerative changes or loose bodies, surgery may be required.
“Little leaguer’s shoulder” refers to an injury involving a growth plate in the proximal humerus bone that occurs due to the high torsional stresses placed on the shoulder with repetitive pitching. The young pitcher with this injury usually experiences a several month history of mild shoulder pain that escalates to severe shoulder pain during a pitching outing. The coach may notice a loss of pitching control or velocity. Again, early recognition is important. Treatment consists of rest and range of motion exercises until pain resolves followed by a rotator cuff strengthening program.
The best treatment for both of these conditions is prevention!