What are the treatments for an elbow stress fracture in a baseball pitcher? How can he return to pitching quickly and safely?

Oscar in 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.

Treatment of a stress fracture

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.

Treatment of an elbow stress fracture

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.

Pitchers with an elbow stress fracture must stop throwing.

Exercises to train and recover

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.

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