An elbow injury is particularly common in youth baseball, especially for a pitcher. There are many growth centers in the developing elbow that are vulnerable to the repetitive stresses that come with the throwing motion. This article discusses some of the common elbow injuries in youth pitching.
Elbow injury #1: Olecranon apophysitis
The olecranon is the bony prominence on the posterior (back) tip of the elbow. Throwing places quite a bot of shear forces on this area. Repetitive pitching can cause an overuse injury to the growth center of this bone. The surgeon will usually find point tenderness directly on this bony area. X-rays often show widening of this growth area. Occasionally an olecranon stress fracture can occur with repeated stress. Treatment usually involves rest and activity modification, although avulsion injuries and stress fractures can require operative fixation.
4 risk factors for youth pitching injuries
Elbow injury #2: Panner’s disease
Panner’s disease is a benign cause of pain of the lateral (side away from the midline) side of the elbow. It almost always affects children under 10 years old. Rest from throwing until pain resolves is often adequate to treat the condition.
Elbow injury #3: Osteochondritis dissecans of the capitellum
Repetitive compression of the lateral elbow from throwing can injure the bone under the articular cartilage of the capitellum (bony part of the lateral elbow). Young gymnasts who use their upper extremities for weightbearing can also suffer this injury. A young pitcher might notice lateral elbow pain with throwing. Locking or catching felt on that side of the elbow could indicate a more severe injury. X-rays and an MRI can reveal the lesion. If the diagnosis is made early in a skeletally immature athlete, rest and activity modification might allow this lesion to heal. If the osteochondritis dissecans lesion breaks off, the nonoperative treatment might fail. Arthroscopic surgery to remove the fragment, drill holes in the lesion, or replace the lesion with a cylinder of bone and cartilage could be needed.
Elbow injury #4: Medial epicondyle apophysitis
The growth center on the medial (side closest to the midline) side of the elbow is subject to tension forces with the pitching motion. With increased throwing, a young pitcher might notice increasing pain on the medial epicondyle (bony prominence on the medial elbow). The doctor will observe point tenderness at that bony area. X-rays of the elbow often show widening of this growth center. Treatment of this injury involves a period of rest from throwing until pain resolves.
Elbow injury #5: Medial epicondyle avulsion fracture
A fracture of the medial epicondyle can occur with repeated stress of that growth center. The medial elbow pain can slowly increase until the pitcher feels a sharp pain during the pitch. On the other hand, he might not remember a specific traumatic event but continued soreness. He might complain of decreased velocity or inability to locate pitches. X-rays demonstrate the avulsion of the medial epicondyle. Even mild displacement in the elbow of a throwing athlete can be an indication for surgical treatment with reduction and fixation with screws.
Elbow injury #6: Ulnar collateral ligament injuries – “Tommy John injuries”
Historically, ulnar collateral ligament (UCL) injuries primarily affected professional pitchers. These injuries now often occur in younger overhead athletes. Overuse is thought to be the main risk factor. Gradually increasing medial elbow and forearm pain with throwing is standard. Loss of velocity or decreased ability to locate pitches can develop as well. Physical exam, including stress tests for the ulnar collateral ligament, can suggest this injury. X-rays are often normal. An MRI or MR arthrogram can reveal partial or complete disruption of the ligament. Surgery to reconstruct a new UCL with a tendon graft (“Tommy John surgery”) is often necessary in high-level throwing athletes.
These elbow injuries often result from overuse – throwing too many pitches, not getting enough rest, pitching year round and more. Fortunately, if a young pitcher starts to experience elbow pain, taking a few days off might be enough to relieve the pain. Continuing to pitch through pain increases the risk of developing a serious elbow injury. Parents and coaches of an injured young pitcher should take the child to see a sports medicine doctor for evaluation before the elbow injury gets worse.
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