Preseason Assessment of Radiographic Abnormalities in Elbows of Little League Baseball Players

Pennock, Andrew T.; Pytiak, Andrew V; Stearns, Phillip; Roocroft, Joanna H.; Dwek, Jerry R.; Kruk, Peter; Bastrom, Tracey P.

doi:10.2106/jbjs.15.01017

Cited by 31 publications

(30 citation statements)

References 21 publications

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“…Prior research has shown that overhead athletes, particularly baseball players, may be asymptomatic but still have abnormalities on MRA. 22 , 30 , 42 Thus, the combination of a clinical examination was required to make the diagnosis of a UCL injury. It should be noted that ultrasonography with an experienced operator is another imaging modality that can be used to make a diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Trends in Sports-Related Elbow Ulnar Collateral Ligament Injuries

Zaremski

McClelland

Vincent

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:Elbow ulnar collateral ligament (UCL) injuries are common, particularly in adolescent athletes playing overhead sports. While the incidence and outcomes of surgical UCL injuries are well documented, the nonsurgical UCL injury patterns and injury management in this population are not yet known.Purpose/Hypothesis:The purpose of this study was to retrospectively assess the injury severity and subsequent management of UCL injuries among competitive athletes aged 11 to 22 years. We hypothesized that nonsurgical UCL injuries would occur more frequently in younger athletes compared with older athletes.Study Design:Descriptive epidemiological study.Methods:Electronic medical records (using International Classification of Diseases, 9th Revision and 10th Revision and Current Procedural Terminology codes) and keyword searches were used to identify all patients with sports-related UCL injuries between January 2000 and April 2016. A total of 136 records were included. Patients were stratified into 3 age brackets (age 11-13 years, n = 17; age 14-16 years, n = 49; age 17-22 years, n = 70). There were no prior elbow surgical interventions. The main outcome measures included the frequency and severity of UCL injuries and injury management (surgical, nonsurgical). Independent variables included age, UCL injuries per year, and sport classification.Results:There were 53 surgical and 83 nonsurgical UCL injuries. The number of nonsurgical cases increased 9-fold from 2000-2008 to 2009-2016. The UCL injuries were distributed as follows: 60 sprains, 39 partial tears, 36 ruptures, and 1 rerupture. Moreover, 7% of sprains, 51% of partial tears, and 78% of ruptures underwent UCL reconstruction. Nonsurgical management was most common in the youngest athletes (age 11-13 years, 100.0% of total injuries; age 14-16 years, 71.4% of total injuries; and age 17-22 years, 44.3% of total injuries) (P = .007). UCL injury volume was most commonly associated with javelin (odds ratio, 6.69; 95% CI, 0.72-61.62; P = .07) and baseball (odds ratio, 1.55; 95% CI, 0.69-3.51; P = .32).Conclusion:Younger athletes sustained less severe UCL injuries more often than older athletes. Participation in javelin and baseball was associated with a greater likelihood of UCL injuries based on our dataset. This is the first study to provide data on the volume of nonsurgical UCL injuries among athletes in various sports.

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Section: Discussionmentioning

confidence: 99%

Trends in Sports-Related Elbow Ulnar Collateral Ligament Injuries

Zaremski

McClelland

Vincent

et al. 2017

Orthopaedic Journal of Sports Medicine

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“…6 Multiple potential risk factors may be responsible, including year-round play, pitching for more than 1 team, pitch velocity, player height and weight, and loss of shoulder internal rotation. 1,9,18,19,22…”

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confidence: 99%

Shoulder MRI Abnormalities in Asymptomatic Little League Baseball Players

Pennock

Dwek

Levy

et al. 2018

Orthopaedic Journal of Sports Medicine

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Background:Youth baseball is extremely popular in the United States, but it has been associated with shoulder pain and injury. The incidence of shoulder abnormalities in this athletic population has yet to be defined.Purpose:To examine abnormalities noted on magnetic resonance imaging (MRI) in the shoulders of asymptomatic Little League baseball players and to correlate these findings with the players’ throwing history and physical examinations.Study Design:Case-control study; Level of evidence, 3.Methods:A total of 23 Little League baseball players aged 10 to 12 years were recruited. All players underwent a comprehensive physical examination and responded to a questionnaire addressing their playing history and any arm or shoulder pain. Bilateral shoulder MRIs were performed and read in a blinded manner by 2 radiologists. Responses on the questionnaire and physical examination findings were compared between participants with and without positive MRI findings through use of chi-square test and analysis of variance.Results:The dominant arm was 8.5 times more likely to have an abnormality on MRI compared with the nondominant arm. In all, 12 players (52%) had 17 positive MRI findings in their throwing shoulder that were not present in their nondominant shoulder. These findings included edema or widening of the proximal humeral physis (n = 5), labral tear (n = 4), partial rotator thickness tear (n = 4), acromioclavicular joint abnormality (n = 2), subacromial bursitis (n = 1), and cystic change of the greater tuberosity (n = 1). Two primary risk factors were associated with an abnormal MRI: year-round play and single-sport athletes focusing solely on baseball (P < .05). Players with no risk factors, 1 risk factor, and both risk factors had a 25%, 71%, and 100% chance, respectively, of having an abnormal MRI. A majority of players (61%) had previously experienced shoulder pain, especially pitchers throwing curveballs and sliders (P < .05), but this was not associated with an abnormal MRI.Conclusion:Abnormalities seen on MRI involving the shoulder are common in Little League baseball players, especially those who are single-sport athletes playing year-round.

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“…11 In relation to this, it has recently been shown that more than one-third of Little League baseball players had abnormal preseason magnetic resonance imaging findings of the elbow. 15 Pitching is a common mechanism of injury in baseball. 5,14 Olsen et al 14 found that adolescent 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%

An Epidemiological Comparison of Elbow Injuries Among United States High School Baseball and Softball Players, 2005-2006 Through 2014-2015

Pytiak

Kraeutler

Currie

et al. 2017

Sports Health: A Multidisciplinary Approach

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Background:Pitching is a common mechanism of injury in baseball, with known risk factors for elbow injuries among adolescent pitchers.Hypothesis:Elbow injury rates and mechanisms will differ between high school baseball and softball players.Study Design:Descriptive epidemiology study.Level of Evidence:Level 3.Methods:Baseball- and softball-related injury data from the 2005-2006 through 2014-2015 academic years were collected from the High School Reporting Information Online (RIO) Internet-based data collection tool. Athlete-exposure (AE) and injury data were collected by certified athletic trainers. Rate ratios (RRs) were calculated comparing injury rates in the 2 populations. Injury proportion ratios (IPRs) comparing elbow injuries in pitchers and nonpitchers were calculated as the proportion of all elbow injuries in pitchers divided by the proportion of all elbow injuries in nonpitchers.Results:A total of 214 elbow injuries in male baseball players occurred over 2,327,774 AEs, for an overall elbow injury rate of 0.92 per 10,000 AEs. A total of 75 elbow injuries were reported in female softball players over 1,731,644 AEs, for an overall rate of 0.43 per 10,000 AEs. The rate of elbow injury was significantly higher for baseball than softball (RR, 2.12; 95% CI, 1.64-2.77). A significantly greater proportion of elbow injuries in baseball were pitching-related compared with those from softball, with 50.2% occurring while pitching in baseball versus 11.0% in softball (IPR, 4.58; 95% CI, 2.35-8.93). If all injuries occurring during pitching were removed from both sports, the difference in elbow injury rate for baseball and softball would no longer be significant (RR, 1.19; 95% CI, 0.88-1.62).Conclusion:The rate of elbow injuries is significantly higher in baseball than softball. This is attributable to differences in rates of pitching-related injuries between these 2 groups.Clinical Relevance:These results demonstrate that overhand pitching increases risk of elbow injury in high school athletes.

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Preseason Assessment of Radiographic Abnormalities in Elbows of Little League Baseball Players

Abstract: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cited by 31 publications

References 21 publications

Trends in Sports-Related Elbow Ulnar Collateral Ligament Injuries

Trends in Sports-Related Elbow Ulnar Collateral Ligament Injuries

Shoulder MRI Abnormalities in Asymptomatic Little League Baseball Players

An Epidemiological Comparison of Elbow Injuries Among United States High School Baseball and Softball Players, 2005-2006 Through 2014-2015

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