Arm Pain in Youth Baseball Players

Makhni, Eric C.; Morrow, Zachary S.; Luchetti, Timothy J.; Mishra‐Kalyani, Pallavi S.; Gualtieri, Anthony P.; Lee, Randall W.; Ahmad, Christopher S.

doi:10.1177/0363546514555506

Cited by 89 publications

(83 citation statements)

References 8 publications

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“…In accordance with the increase in the number of participants in overhead throwing sports, there has been an increase in the incidence of upper extremity injuries in the past decades 53. To date, 25% of Major League pitchers and 15% of Minor League pitchers have had Tommy John surgery at some point in their career 5.…”

Section: Considerationmentioning

confidence: 99%

Review of Jobe et al (1986) on reconstruction of the ulnar collateral ligament in athletes

et al. 2018

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This classic examines the landmark publication ‘Reconstruction of the Ulnar Collateral Ligament in Athletes’ by Jobe et al, published in 1986. Dr Frank W Jobe was the first to perform and describe a standard technique for ulnar collateral ligament (UCL) reconstruction with the use of a figure-of-eight configuration and submuscular ulnar nerve transposition to treat throwing athletes with UCL insufficiency. Before Jobe’s pioneering work, the initial operative approach to patients with UCL tears involved repair of the native ligament. Despite this treatment, injuries of the UCL were considered career-ending in those days. The original article describes the surgical technique for UCL reconstruction and the postoperative rehabilitation and outcomes in 16 throwing athletes, including Major League Baseball pitcher Tommy John (Los Angeles Dodgers). Jobe reported good results, with 10 of the 16 patients returning to their previous level of participation in sports, one patient returning to a lower level of participation and five patients retiring from professional athletics due to reasons not related to the operation. However, a high incidence of ulnar nerve complications was reported, requiring secondary surgery in two patients. In the decades following the original publication by Jobe et al, modifications of the Jobe technique, involving different graft choices, tunnel positions, and graft configurations and fixation methods have resulted in improved clinical results. Originally presented as a treatment option for elite athletes only, UCL reconstruction has gained public interest as incidence rates of ‘Tommy John surgery’ have reached epidemic proportions, especially in high school-aged baseball pitchers in the USA.

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Section: Considerationmentioning

confidence: 99%

Review of Jobe et al (1986) on reconstruction of the ulnar collateral ligament in athletes

et al. 2018

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“…Lyman et al 2) found that at least 50% of youth pitchers had experienced pain in the shoulder and elbow while throwing. In an epidemiological study of 218 baseball players aged 8 to 18 years, Makhni et al 3) reported that only 26% of players never experienced arm pain related to throwing. Additionally, it has been reported that 5% of youth baseball pitchers sustain shoulder or elbow injuries severe enough to either require surgery or result in their retirement from the sport 4) .…”

Section: Introductionmentioning

confidence: 99%

Impact of physical functions on location of arm pain in youth baseball players

Nakamura

Edama

Kikumoto

et al. 2019

JPFSM

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The impact of characteristic physical functions on location of arm pain in youth baseball players is unclear. This study aimed to identify the differences in characteristic physical functions between youth baseball players with and without throwing-related arm pain and to clarify these differences according to location of shoulder and elbow pain during pitching. One-hundred nine junior high school baseball players (aged 12-15 years) who participated in a medical checkup underwent clinical assessment, ultrasonography, and physical function measurements. Bilateral passive range of motion (ROM) of the shoulder and elbow were measured. Shoulder muscle tests measured the strength of the throwing arm. Before the examinations, participants completed a questionnaire about their age, gender, years of play, and position in baseball. Participants were divided into 4 groups according to arm pain: non-injured group (no pain), shoulder pain group, medial elbow pain group, and osteochondritis dissecans (OCD) of the humeral capitellum group. Group differences in physical function and baseball exposure variables were analyzed through parametric and nonparametric tests. Twenty-six players sustained throwing-related pain in the shoulder or elbow. Elbow extension and flexion deficits were significantly greater with elbow injury. Our study suggests that dominant elbow extension and flexion ROM may increase the risk of throwing-related elbow pain in junior high school baseball players. We could not clarify the characteristics of shoulder pain in this study; thus, further research is required to improve understanding of these characteristics and their implications.

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“…9,10,15 In a survey of youth baseball players, only 26% reported that their arm never hurt while throwing. 11 Pitching, in particular, is a common mechanism of injury in baseball. 3,12 Olsen et al 12 found that pitchers with injuries to the shoulder and elbow pitched significantly more months per year, games per year, innings per game, pitches per game, pitches per year, and warm-up pitches per game.…”

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confidence: 99%

Are the Current Little League Pitching Guidelines Adequate? A Single-Season Prospective MRI Study

Pytiak

Stearns

Bastrom

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:Little League throwing guidelines have recently been implemented in an attempt to lessen the growing number of elbow injuries occurring in youth baseball players.Hypothesis/Purpose:The purpose of this study was to examine pre- and postseason changes seen on magnetic resonance imaging (MRI) in youth baseball players’ elbows in an attempt to identify risk factors for pain and MRI abnormalities, with a particular focus on the current Little League guidelines. We hypothesized that MRI abnormalities would be common in pitchers with high pitch counts and poor guideline compliance.Study Design:Cohort study; Level of evidence, 2.Methods:A prospective study of Little League players aged 10 to 13 years was performed. Players were recruited prior to the start of the season and underwent bilateral elbow MRI as well as a physical examination and completed a questionnaire addressing their playing history and arm pain. At the end of the season, a repeat MRI and physical examination were performed. MRIs were read by blinded radiologists. During the season, player statistics including innings played, pitch counts, and guideline compliance were recorded. Physical examination findings and player statistics were compared between subjects with and without MRI changes utilizing chi-square and analysis of variance techniques.Results:Twenty-six players were enrolled. Despite 100% compliance with pitching guidelines, 12 players (48%) had abnormal MRI findings, and 28% experienced pain during the season. There was a significant difference in distal humeral physeal width measured pre- to postseason (1.54 vs 2.31 mm, P < .001). There was a significant loss of shoulder internal rotation during the season, averaging 11°. While pitch counts, player position, and throwing curveballs/sliders were not significantly associated with changes seen on MRI, year-round play was associated with abnormalities (P < .05). Much lower compliance (<50%) was observed with nonenforced guidelines, including avoidance of single-sport specialization, year-round play, and throwing curveballs/sliders.Conclusion:Arm pain and MRI abnormalities of the medial elbow are common in Little League baseball players who comply with the Little League throwing guidelines, especially those playing year-round.

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Arm Pain in Youth Baseball Players

Abstract: A majority of healthy (actively competing) youth baseball players report at least some baseline arm pain and fatigue, and many players suffer adverse psychosocial effects from this pain.

Cited by 89 publications

References 8 publications

Review of Jobe et al (1986) on reconstruction of the ulnar collateral ligament in athletes

Review of Jobe et al (1986) on reconstruction of the ulnar collateral ligament in athletes

Impact of physical functions on location of arm pain in youth baseball players

Are the Current Little League Pitching Guidelines Adequate? A Single-Season Prospective MRI Study

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