Baseball is big in Acadiana and with the arrival of spring, the practice fields and diamonds are abuzz with activity. Thousands of children throughout Louisiana play youth baseball under the supervision of adult coaches, administrators, and parents. Many play in community based or area leagues and many play representing their respective schools. Some even participate on select traveling squads and may even play year round! The bottom line is, especially for young pitchers, lots and lots of throwing!
Over 35 years ago physicians recognized the risk to the upper extremity, especially the shoulder and elbow, in the growing child. According to a the Sports Trauma and Overuse Prevention (STOP) Sports Injury campaign, over 20% of players age 8-12 and 45% of players age 13-14 will report arm pain in a single season. Most of these issues occur in pitchers and are related to chronic overuse injury.
As an orthopedic surgeon, some are the shoulder problems I see are:
Little League Shoulder - pain in the shoulder due to stress and widening of the growth plate of the upper end of the humerus
Rotator cuff strains and impingement – tendinitis and inflammation of the rotator cuff due to excessive force and fatigue
Instability and labrum tears – stretching of the ligaments and capsule of the shoulder or possibly detachment of the labrum cartilage.
Many of the injuries occur at the elbow and are primarily due to the valgus stress that occurs in the throwing motion. Some of the more common injures are as follows:
Little League Elbow – inflammation or stress reaction at the growth plate on the medial (inside) aspect of the humerus at the elbow. Sometimes a fracture can occur here too
Ulnar Collateral Ligament (UCL) sprain or tear – partial tears can sometimes be treated with bracing and rehab but complete tears may require Tommy John surgery
OCD (Osteochondritis Dessicans) and Panner’s disease – involve the growth plates and cartilage on the lateral (outer) aspect of the elbow and can range from asymptomatic to severe
Dr. James Andrews, arguably the world’s most famous orthopedic surgeon and one of the leading experts in our field, along with others, has identified many of the risk factors that can lead to injury in these young athletes. These risk factors include year round baseball, fatigue, velocity, and poor pitching mechanics. Another situation which increases risk is when the young pitcher also plays catcher. Use of the curveball at too young an age was also previously thought to be a risk factor but this has not been scientifically proven.
The good news is that most of these injuries can be prevented! In 2006, Little League Baseball developed recommendations regarding pitch count and rest days for young pitchers and more recently, Major League Baseball and USA Baseball have launched the Pitch Smart campaign. This campaign, which is supported by Little League Baseball and the American Sports Medicine Institute, is an educational effort for programs, coaches, and parents to assist them in preventing these injuries in young baseball players.
By following the preventive recommendations of the above mentioned organizations, stressing the importance of overall physical fitness, and even encouraging these young athletes to participate in other sports, we as medical providers, coaches and parents can help our young baseball players enjoy their sport for many years, remain injury free and avoid long term consequences. Be smart, play smart, and have fun!
For more information visit www.littleleague.org or http://m.mlb.com/pitchsmart.