Elbow injuries in youth baseball players without prior elbow pain
Matsuura T, Suzue N, Kashiwaguchi S, Arisawa K, Yasui N. The Orthopaedic Journal of Sports Medicine. 2013;1(5):1-4.
Take Home Message: Up to 30% of youth baseball players may develop elbow pain yearly. Risk factors for elbow pain among youth baseball players is being older, playing as a pitcher or catcher, and/or playing more than 100 games a year.
There is a rapid rise in the rate of elbow injuries among youth baseball athletes. This may be attributable to many risk factors (e.g., immature skeleton, throwing mechanics, pitch type); however, there is little evidence to support these factors. We need to understand which factors may increase the risk of elbow pain among youth baseball athletes to implement prevention-conditioning programs and determine safe rules and regulations to prevent elbow injuries in this population. Therefore, the researchers investigated risk factors that could predispose youth baseball players without prior history of elbow pain to elbow injuries. Four hundred and forty-nine youth baseball players (mean 10.1 years of age, range 7-11 years) from a regional summer championship, who had no prior elbow pain, completed a questionnaire after 1 season (1 year). The athletes with the help of their coach and/or parent(s) answered if they experienced elbow pain during the season. The athletes also reported their playing position, practices per week, and number of games per year. If an athlete reported elbow pain, the authors recommended a physical examination (e.g., range of motion, tenderness, valgus stress test). Radiographic examinations were recommended to athletes who had a positive examination (e.g., 5o difference in range of motion between throwing and nonthrowing arm). Thirty percent of the youth baseball athletes (137 athletes) developed elbow pain over the one-year period. Among those athletes, 72% (99 athletes) presented abnormal findings during a physical examination. Athletes with elbow pain displayed limited elbow extension (32 athletes), limited elbow flexion (46 athletes), positive tenderness (65 athletes), and/or positive valgus stress test (44 athletes) during the physical examination. Eighty-six of the athlete with a positive physical examination agreed to undergo elbow radiography. Sixty-eight athletes exhibited medial epicondylar fragmentation and 2 athletes displayed osteochondritis dissecans of the capitellum. The authors found three key risk factors associated with developing elbow pain: 1) being 12 years of age compared with players under 10 years, 2) playing as a catcher or pitcher compared with an outfielder, and 3) playing over 100 games/year compared with playing less than 50 games/year. The number of practice days per week was not related to developing elbow pain.
These authors demonstrated that around 30% of youth baseball athletes with no prior history of elbow pain may develop elbow pain within a year, and over 60% (86/127) of these cases will display abnormal radiographs. An intrinsic factor that could lead to elbow pain was being 12 years of age. Older youth athletes may begin to play more games, but it would be interesting to note if throwing mechanics or velocity changes as the athlete gets older. Position was an important extrinsic factor related to elbow pain, where pitchers and catchers have an increased risk for elbow pain. These two positions throw more than other field players so the volume of throws as well as their mechanics may help explain why these players are at greater risk. Additionally, playing more than 100 games/year increased the risk of elbow pain, which suggests that playing at such a high volume of games may not allow enough time for recovery. Together these findings may further support the hypothesis that players who expose their elbows to higher loads (e.g., older athletes, pitchers, catchers) and more repetitions (e.g., pitchers, catchers, playing over 100 games/year) may be at risk for elbow pain. One limitation of this study was that only youth baseball athletes that participated in the regional championship participated in this study. Therefore, this data may not be generalizable to other youth baseball athletes. Despite this limitation medical professionals should be aware of these risk factors, and ensure an inclusive history (e.g., position, how many games a year), and educate the athlete and parents about these risk factors to help prevent elbow injuries.
Questions for Discussion: In addition to pitch counts should there be catcher throw counts as well? Do you believe other factors may play a role in elbow pain such as pitching mechanics or physical conditioning?
Written by: Jane McDevitt, PhD
Reviewed by: Jeffrey Driban