Ask Dr. Geier – Stress Fractures in Pitchers
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David
Oscar in Rowland Heights, California asks:
Hello Dr. Geier,
My son who is 17 has just been diagnosed via MRI with a stress fracture of his elbow. We thought he might have a ligament tear, but the diagnosis was a stress fracture. My question is this. Besides rest and no pitching (cause of pain), what types of things can, or rather should, he be doing during his rehab?
Thanks for the question Oscar. The most common stress fracture in pitchers is an olecranon stress fracture, although specific areas of the humerus can suffer these overuse injuries as well.
Yes, you are correct in that the bottom line with treatment of stress fractures anywhere in the body is typically to stop the activity. For runners with metatarsal stress fractures, tibial stress fractures, or even femoral neck stress fractures, the athlete has to stop running. Depending on the location and nature of the injury, it could require more aggressive treatment and occasionally surgery.
For pitchers with upper extremity stress fractures, the same principle applies. He (or she) has to stop throwing. The rest from throwing eliminates the repetitive stress that caused the injury and allows the body to heal. Occasionally more aggressive treatments are needed, although surgery is rarely necessary.
Fortunately the thrower usually does not have to stop all activity. I usually allow throwers to still get cardiovascular exercise through running, swimming, biking, or other similar activities to maintain fitness. Lifting weights and core strengthening are usually possible and most of the time not dangerous to the injury. They also help the athlete to return to pitching quickly when the surgeon has cleared him to pitch again. And for throwers, I usually still have them perform their maintenance shoulder and elbow strengthening programs that they have been doing throughout the season even with these injuries. Usually rotator cuff and scapulothoracic exercises are not harmful for elbow injuries. If there is any question, the thrower should check with his physician.
C. David Geier Jr., M.D.
2 Comments
Hi, Dr.Geier
My son is 11 yr old left handed pitcher, this past july he had a small avulsion fracture from the humeral epicondyle where the common flexor tendon and ucl attaches, approximately 2 mm cortical separation. And a partial sprain of UCL. He had physical therapy, for a month and didn’t pitch any till this past weekend december 10th, his arm now is stiff when he tries to bend it and is sore on the inside as well, im stressing big time, what should we do, I took him to doctor and he said rest and exercise the arm but im wondering if something else needs to be done, he throws hard for his age, and has a promising future ahead of him and I dont want him to miss it! Please reply with any info, sincerely, alisha #1 baseball mom !!
There is much debate about the treatment of medial epicondyle fractures in young pitchers. Different surgeons have different cutoffs for millimeters of separation, whereas others, including myself, usually treat any degree of displacement surgically. A fracture that is several months old has probably healed, so then attention shifts to physical therapy for range of motion and strengthening. I cannot say specifically what he needs as I haven’t examined him, but his surgeon hopefully can get him back to throwing.