Elbow injuries in
youth baseball players without prior elbow pain
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.
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.
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
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?
by: Jane McDevitt, PhD
by: Jeffrey Driban