By Robert A. Gallo
Late childhood and early adolescence is a period of a tremendous development for the young elbow. During these years, several growth plates emerge and fuse in a coordinated fashion to assume the anatomy required for optimal function. Youth baseball can pose a significant threat to the health of this developing joint. Damage to cartilage, growth plates, and ligaments are common injuries among juvenile pitchers and pose a potentially permanent impedance to normal elbow function.
Over the past decade, there has been an alarming increase in the rate of elbow injuries and surgeries among adolescent pitchers. In one recent study, more than 50 percent of young pitchers admitted to having shoulder and/or elbow pain over the course of two seasons. Among that group, 26 percent of those surveyed complained of elbow pain within the two-year period; a similar study performed 25 years earlier reported only 17 percent of young pitchers ever had elbow symptoms and only 1 percent had limitations secondary to this pain.
While many hypotheses have been proposed as the cause of this “epidemic” — including poor pitching form, premature use of curveballs, and overuse — only overuse has been consistently linked to the development of upper extremity injuries in young pitchers. Compared to pitchers who were not injured, injured pitchers throw significantly more innings, more pitches, and more months throughout a year.
In an attempt to lower injury rates, several of baseball’s governing bodies have issued rules to limit the number of pitches thrown by young pitchers per week. The guidelines set forth by USA Baseball and Little League Baseball are outlined on the American Sports Medicine Institute Web site.
In addition to limiting pitch counts during each season, pitchers should consider and reduce the number of extra throws. Two additional methods of reducing injury are to limit excessive warm-up sessions, and to avoid playing catcher due to the number of throws required during a game. All young pitchers should have a rest period from competition at least four months out of the year and limit the number of special showcases they attend.
Elbow soreness is an important indicator of injury or impending injury and should be taken seriously. If a young pitcher experiences any elbow soreness or requires ice or anti-inflammatory medications such as ibuprofen or Tylenol for comfort, he should avoid throwing until the pain resolves. Any pitcher who continues to have soreness despite an adequate period of rest should consult a physician for further evaluation.
Robert A. Gallo, M.D., is an assistant professor in the Department of Orthopaedics at Penn State Hershey Bone and Joint Institute.