Little League survey: the Houston study

Abstract

1. In a study of 595 Little League pitchers, approximately 17% had a history of elbow symptoms: only 1% had elbow symptoms which had ever excluded them from pitching. There was no correlation between the presence of symptoms and years of pitching experience. 2. Some limitation of active extension of the elbow was seen in 12% of the pitchers; however, there was no correlation between elbow flexion contractures and years of pitching experience, symptoms, or roentgenographic pathology. No normal child had an elbow flexion contracture greater than 15 degrees. 3. A slight valgus carrying angle is considered a normal anatomic variant in the dominant arm. There was no correlation between valgus carrying angle and years of pitching experience or symptoms or roentgenographic pathology. 4. No roentgenographic evidence of avascular necrosis of the capitellum, radial head, or both was seen in this population. 5. Roentgenographic findings such as bony hypertrophy, enlargement of the medial epicondyle, and secondary ossification centers are normal anatomic variants not related to symptoms. Undisplaced stress fractures of the medial epicondyle respond well to conservative treatment, with no functional residual.

Baseball Injuries

“…Overall, the rates of injury in youth and high school baseball are lower than other sports played by children and adolescents, but they still represent a significant cause of injury and potential long-term disability among the participants [18], particularly among pitchers [19][20][21][22][23][24][25][26][27][28].…”

“…Furthermore, continued overuse is believed to eventually result in serious injury or arm-related disability in some pitchers [18]. Table 2 summarizes the findings of studies of elbow and shoulder injury in pitchers published between 1965 and 2002 [19][20][21][22][23][24][25][26][27][28]. In 1965, Adams conducted the seminal epidemiologic study on this issue [19].…”

“…The frequency of arm pain was highest in pitchers. Subsequent studies of American youth and high school players have demonstrated a prevalence of elbow pain between 18 and 29% [22,24,27,28] and an incidence of elbow pain of 26% among youth players and 58% among high school players [20,21,23,25,26]. Shoulder pain has not been studied as frequently with a prevalence of 29% in single study of 9-18-year-old boys [28] and an incidence of 32-35% in two recent studies by Lyman et al [25,26].…”

“…The utility of this information is suspect, because studies often used differing definitions of 'injury'. Some studies required only self-report of injury [13,22,[24][25][26], some required a hospital visit [6], while some required an insurance claim [10,12]. Since abrasions might not require medical attention from a trained health professional or an insurance claim, these are likely greatly under-reported in some studies.…”

“…Gugenheim et al [22] calculated the average pitches per inning for approximately 25% of the pitchers in the study. No association was found between average pitches per inning and self-reported elbow pain.…”