- Epidemiology and Impact of Knee Injuries in Major and Minor League Baseball Players
- Little League Elbow
- Causes and Symptoms of Little League Elbow
- Risk Factors for Developing Little League Elbow
- Little League Elbow Treatment Options
- Little League Elbow in Tampa-St. Petersburg, Florida
- What Is Tommy John Surgery? Recovery Time, Symptoms, and More
- Elbow Problems in Little League Baseball Players
- What is the growth plate?
- How can these conditions be prevented?
Epidemiology and Impact of Knee Injuries in Major and Minor League Baseball Players
Injuries among professional baseball players have been on the rise for several years.
1,2 From 1989 to 1999, the number of disabled list (DL) reports increased 38% (266 to 367 annual reports),1 and a similar increase in injury rates was noted from the 2002 to the 2008 seasons (37%).
2 These injuries have important implications for future injury risk and time away from play. Identifying these injuries and determining correlates and risk factors is important for targeted prevention efforts.
Several studies have explored the prevalence of upper extremity injuries in professional and collegiate baseball players;2-4 however, detailed epidemiology of knee injuries in Major League Baseball (MLB) and Minor League Baseball (MiLB) players is lacking.
Much more is known about the prevalence, treatment, and outcomes of knee injuries in other professional sporting organizations, such as the National Basketball Association (NBA), National Football League (NFL), and National Hockey League (NHL).
4-12 A recent meta-analysis exploring injuries in professional athletes found that studies on lower extremity injuries comprised approximately 12% of the literature reporting injuries in MLB players.
4 In other professional leagues, publications on lower extremity injuries comprise approximately 56% of the sports medicine literature in the NFL, 54% in the NBA, and 62% in the NHL.4 Since few studies have investigated lower extremity injuries among professional baseball players, there is an opportunity for additional research to guide evidence-based prevention strategies.
A better understanding of the nature of these injuries is one of the first steps towards developing targeted injury prevention programs and treatment algorithms.
The study of injury epidemiology among professional baseball players has been aided by the creation of an injury tracking system initiated by the MLB, its minor league affiliates, and the Major League Baseball Players Association.
5,13,14 This surveillance system allows for the tracking of medical histories and injuries to players as they move across major and minor league organizations. Similar systems have been utilized in the National Collegiate Athletic Association and other professional sports organizations.
3,15-17 A unique advantage of the MLB surveillance system is the required participation of all major and minor league teams, which allows for investigation of the entire population of players rather than simply a sample of players from select teams. This system has propelled an effort to identify injury patterns as a means of developing appropriate targets for potential preventative measures.5
The purpose of this descriptive epidemiologic study is to better understand the distribution and characteristics of knee injuries in these elite athletes by reporting on all knee injuries occurring over a span of 4 seasons (2011-2014). Additionally, this study seeks to characterize the impact of these injuries by analyzing the time required for return to play and the treatments rendered (surgical and nonsurgical).
After approval from the Johns Hopkins Bloomberg School of Public Health Institutional Review Board, detailed data regarding knee injuries in both MLB and MiLB baseball players were extracted from the de-identified MLB Health and Injury Tracking System (HITS).
The HITS database is a centralized database that contains data on injuries from an electronic medical record (EMR). All players provided consent to have their data included in this EMR. HITS system captures injuries reported by the athletic trainers for all professional baseball players from 30 MLB clubs and their 230 minor league affiliates.
Additional details on this population of professional baseball players have been published elsewhere.5 Only injuries that result in time play (≥1 day missed) are included in the database, and they are logged with basic information such as region of the body, diagnosis, date, player position, activity leading to injury, and general treatment.
Any injury that affects participation in any aspect of baseball-related activity (eg, game, practice, warm-up, conditioning, weight training) is captured in HITS.
All baseball-related knee injuries occurring during the 2011-2014 seasons that resulted in time sport were included in the study. These injuries were identified the Sports Medicine Diagnostic Coding System (SMDCS) to capture injuries by diagnostic groups.18 Knee injuries were included if they occurred during spring training, regular season, or postseason play.
Offseason injuries were not included. Injury events that were classified as “season-ending” were not included in the analysis of days missed because many of these players may not have been cleared to play until the beginning of the following season.
To determine the proportion of knee injuries during the study period, all injuries were included for comparative purposes (subdivided 30 anatomic regions or types).
For each knee injury, a number of variables were analyzed, including diagnosis, level of play (MLB vs.
MiLB), age, player position at the time of injury (pitcher, catcher, infield, outfield, base runner, or batter), field location where the injury occurred (home plate, pitcher’s mound, infield, outfield, foul territory or bullpen, or other), mechanism of injury, days missed, and treatment rendered (conservative vs surgical). The classification used to describe the mechanism of injury consisted of contact with ball, contact with ground, contact with another player, contact with another object, or noncontact.
Little League Elbow
A common problem among young adolescent baseball players, little league elbow is a growth plate injury to the inner part of the elbow that occurs as a result of repetitive throwing motions. Most patients are able to return to their favorite sport pain-free after a period of rest and conservative treatments.
Contact the Children's Orthopaedic and Scoliosis Surgery Associates for more information regarding little league elbow treatment options »
Causes and Symptoms of Little League Elbow
A common problem among young adolescent baseball players, little league elbow is a growth plate injury to the medial (inner) part of the elbow that occurs as a result of repetitive throwing motions. The growth plate is the attachment site for the group of muscles that flex the wrist and rotate the forearm.
Little league elbow is most often the result of repetitive throwing motions, which can create an overload or overstress injury to the medial elbow. During the throwing motion, a large amount of tension is placed on the medial elbow structures that can cause injury to the growth plate of the medial (inside) of the elbow.
If left untreated, little league elbow can become more severe, causing ligaments and tendons tears. In addition, tearing may cause tiny bone fragments to break off and travel to other areas of the elbow joint, disrupting normal bone growth, resulting in deformity.
Patients suffering from little league elbow often report a gradual increase of medial elbow pain and stiffness, particularly while throwing. As the condition progresses, the child will often experience a decrease in throwing velocity and effectiveness.
Risk Factors for Developing Little League Elbow
Adolescent pitchers, and other adolescent players who throw repetitively, have a high risk of developing little league elbow.
If left untreated, little league elbow can lead to major complications and jeopardize a child's ability to remain active in a sport, such as softball.
Other factors that contribute to the development of little league elbow and the increased injury rates seen in pediatric athlete include:
- Increased single-sport participation with year-round training
- Participation in higher intensity sports at younger ages
- Longer competitive seasons
- Conditioning and training errors
However, overuse injuries, such as little league elbow, can often be prevented. Prevention techniques include:
- Proper warm-up (including stretching, running, easy and gradual throwing)
- Rotate positions while on the field
- Concentrate on age-appropriate pitching
- Adhere to pitching count guidelines
- Avoid pitching on multiple teams with overlapping seasons
- In the event of elbow pain, do not pitch
- Communicate regularly about how your arm feels
- Emphasize control, accuracy, and good mechanics
Little League Elbow Treatment Options
If caught early enough and treated properly by a pediatric orthopaedic physician, little league elbow will heal completely and not cause any permanent elbow damage. To ensure a proper diagnosis, the orthoapedic physician will review the patient’s symptoms, clinical examination results, and x-rays.
Little league elbow treatment options are dependent on the extent of the growth plate injury. Left untreated, throwing injuries in the elbow can be very complex. However, younger children tend to respond better to non-surgical treatments, such as:
- Rest the affected area
- Apply ice packs to bring down any swelling
- Utilize non-steroidal anti-inflammatory drugs (NSAIDS)
If pain persists after a few days of complete rest of the affected arm, or if pain recurs when throwing is resumed, it is recommended that the child stop the activity until cleared by a pediatric orthopaedic physician.
the severity of the injury, a 6-week period of rest may be recommended. Upon approval from the physician, a slow progressive throwing program may be instituted over the next 6-8 weeks.
While rare, surgery or casting is occasionally necessary to relieve pain symptoms.
Little League Elbow in Tampa-St. Petersburg, Florida
Dr. Drew Warnick and Dr. Paul Benfanti are board-certified sports medicine specialists at Children’s Orthopaedic and Scoliosis Surgery Associates, renowned for their high quality care in the treatment of pediatric sports injuries. To learn more about Children’s Orthopaedic’s sports medicine specialties, schedule an appointment at one their four Tampa Area offices.
What Is Tommy John Surgery? Recovery Time, Symptoms, and More
Tommy John surgery is another term for ulnar collateral ligament (UCL) reconstruction. It’s a procedure to treat an elbow injury that tends to occur among throwing athletes, such as baseball pitchers. Tommy John was a long-time Major League Baseball pitcher, and he was the first to have this now-common surgery.
Tommy John surgery repairs a torn UCL, a ligament on the inside of your elbow that’s crucial to the stability of the joint. The UCL and the lateral collateral ligament connect the humerus — the long bone in the upper arm — to the ulna, one of the main bones in the forearm.
When the ulnar ligament tears, you may actually hear a “pop.” After that, you may not be able to throw or do much of anything with that arm until it’s treated. Your inner elbow may be sore prior to you actually tearing the ligament. The soreness is due to a strain being placed on the ligament itself.
Other signs of an ulnar collateral ligament tear include:
- swelling of the inside part of the elbow and the upper forearm
- a bruise forming at the site of the injury
- elbow stiffness and an inability to fully straighten your arm
- tingling in the hand and the little finger and ring finger
- weak hand grip
The stress of repeated throwing motions can cause the fibers in the ulnar ligament to stretch and fray. Over time, small muscle tears (known as microtears) can develop. Eventually, those little injuries take their toll and the ligament ruptures.
Children from the ages of 10 to 18 are experiencing more UCL injuries. The condition is becoming more common as young athletes compete in more games and in longer seasons. Their risk is made more serious because they have an open growth plate in the elbow. It’s called the medial epicondylar physis, also known as little league elbow.
Sometimes falling with your arm outstretched can injure the elbow and cause a UCL tear as well.
Before scheduling Tommy John surgery, your doctor may recommend rest and some rehabilitation exercises. These exercises will improve posture, strength, and throwing techniques. Anti-inflammatory medications may also be recommended for pain.
If surgery is needed, however, your doctor may be able to do it arthroscopically. An arthroscope is a special tool that’s fitted with a small fiber-optic television camera. It’s inserted into the elbow through a small incision.
The camera sends images to a computer screen, which allows the doctor to see the inside of the joint and the soft tissues (including the ligaments).
During arthroscopic surgery, your doctor may be able to smooth out any frayed or rough edges and remove any dead or injured tissue.
A more involved Tommy John procedure requires an open incision. It’s necessary if the ligament has been pulled away from the bone. Instead of repairing the existing but damaged UCL, a tendon taken from elsewhere in the body is used to replace it.
The replacement tendon is attached to the bones through holes that are drilled into the humerus and ulna. The tendon is threaded through the holes and held in place with sutures or screws.
The replacement tendon usually comes from the hamstring, the forearm, and the foot (big toe extensor tendon).
A baseball pitcher could require a year or more of rehabilitation before they’re back in top form. Research shows that in a study of 179 Major League Baseball pitchers who underwent Tommy John surgery, 148 were able to return to pitch in the major leagues again after the operation. Another 26 were able to return to pitch at the minor league level.
Rehabilitating after Tommy John surgery can be divided into three phases. The duration of each phase depends on the individual and the nature of the surgery. If there was more damage to the elbow than just the ligament tear, recovery may take longer. The three phases of rehabilitation include:
- Phase 1. After surgery, your arm will be placed in a brace. This brace will stabilize your arm at an angle of 60 to 90 degrees. You’ll still be able to do exercises for your biceps, shoulder, and hand. These exercises are important to keep your muscles from atrophying.
- Phase 2. About two weeks after surgery, you’ll be given the go-ahead to move your elbow joint. The goal of physical therapy at this point is to improve your range of motion. Your arm will still be in a brace of some sort when you’re not using it. The brace could have hinges to keep your elbow stable while you’re exercising the joint. You may also rest your arm in a sling while your elbow continues to heal.
- Phase 3. After a month or so, your elbow can come the brace and you should be able to fully extend your arm. Within a few months, you should regain a full range of motion in your elbow. Physical therapy during this phase will include flexibility and strengthening exercises.
Tommy John surgery, other operations, runs the risk of infection or complications due to anesthesia. There is also a low risk of damage to blood vessels or nerves in the elbow. If the ulnar nerve is being irritated as a result of the surgery, it can be moved to another part of the elbow.
Other complications relate to the replacement tendon. The new tendon that’s attached to the bones in the elbow joint may stretch and tear, requiring a second operation. In rare cases, complications develop in the part of the body from which the replacement tendon was harvested. These can usually be treated effectively with medication.
During your recovery, it’s critical that you to pay attention to signs of complications or setbacks, or signs that your elbow isn’t ready for the burden of your sport. Talk with your doctor and trainers about what to be on the alert for after surgery.
A typical Tommy John surgery requires an incision about 4 inches long on the inside of the elbow. The resulting scar, which forms a “C” when your elbow is bent, will fade somewhat. But it will always be a visible reminder of your operation — and hopefully healthy recovery.
Tommy John surgery can extend an athlete’s career as long as they follow the advice of their healthcare providers. Completing physical therapy is key, as is being patient during recovery. If you accept that the recovery process can’t be rushed, you could be back in action and performing at a high level thanks to this operation named for a high-achieving athlete.
Elbow Problems in Little League Baseball Players
Linkedin Pinterest What You Need to Know
- Because pitchers throw hard and often, they are most at risk for elbow and shoulder problems associated with throwing.
- Stress from throwing is absorbed in the cartilage at the ends of the bones in young baseball players where growth plates are located.
- Signs of damage include pain when throwing, pain after throwing, swelling around the elbow and loss of motion.
Throwing a baseball can put tremendous amounts of stress upon the throwing arm of both adults and younger baseball players.
In adults, the stress is absorbed by the ligaments and tendons and as a result they tend to get tendinitis or stretching of the ligaments. However, in growing children, the stress is absorbed by the weakest parts of the bones, which are the cartilage at the ends of the bones.
This cartilage is the part of the bone where growth occurs, and damage to this area can have long-term consequences for the shoulder or elbow.
Repetitive throwing places severe stress on the elbow joint. The throwing motion stretches the tendons and ligaments on the inner side of the elbow and compresses the structures on the outer side. These forces can damage tissue and bone, especially in young athletes whose bones have not fully matured.
What is the growth plate?
The growth plate is a specialized part of the bone located near the joint which is where growing of the bones occurs. This area is not as strong as the bone, ligaments or tendons.
As a result, when the shoulder or elbow feels the stress of a baseball pitch, the growth plate is affected by this stress more than the other structures. This is only a problem if the stress occurs too frequently and if the stress is large.
Players who pitch are at risk the most for these problems because they throw hard and often. This is one of the reasons that the number of innings (and hopefully the number of pitches) allowed by a player are limited by league rules.
The cartilage of the growth plate cannot tolerate excessive stress, and the first sign it is being overworked is pain. Pain in the elbow or shoulder of a growing baseball player is not normal and should not be hidden with ice or medication. If the damage continues after the onset of pain, then the growth plate actually can break.
In the elbow this is usually on the inside of the elbow, and a small piece of the bone where the tendons attach can actually pull off. If severe, this may need surgery to replace the bone.
In the elbow, the cartilage of the joint can actually be damaged as well. If this occurs the elbow may lose the cartilage in the joint on the ends of the bones, which is called arthritis.
Damage to the cartilage in the joint of a young baseball player can result in damage of the joint function for the rest of their lives.
In the shoulder, the growth plate can fracture and cause significant time away from the sport. Rarely the upper arm bone may break if it sees too much stress over time. For these reasons, pain in the shoulder, arm or elbow should not be ignored in a young baseball player.
The earliest sign is pain with throwing, and as the damage progresses the pain can continue after throwing. If the damage becomes worse there may be swelling around the elbow and even loss of motion. In the shoulder the only symptom is pain, and swelling is rarely seen. The pain is usually made worse only by throwing and not by other activities.
An evaluation by a physician will help confirm the diagnosis. Radiographs, or plain X-rays, will sometimes confirm the diagnosis.
On the X-ray, the growth plate damage may show up as widening of the growth plate or damage to the joint.
If the X-rays are normal then it may be necessary to do other studies, such as a bone scan or a magnetic resonance imaging (MRI) scan. These tests may show subtle damage not visible on regular X-rays.
How can these conditions be prevented?
Because these problems are due to the stress of throwing a baseball, these conditions may be preventable by limiting the number of times the athlete throws. The guides provided by most leagues are designed to prevent throwing too many pitches or too many innings.
However, many players throw at practice or at home on their own. Unfortunately there are probably no definite number of pitches that determine when damage occurs. For this reason it is important that the player be honest about having pain and the adults involved inquire frequently about any discomfort reported by the player.
It is important not to try to hide the pain or ignore its presence.