Orthopedic surgeons focus on new ways to prevent arm injuries among young baseball players

Throwing arm injuries are on the rise in Little League and other youth baseball programs. After these injuries occur, many players are out for the season; others require surgery and must refrain from play for an even longer duration; still others sustain injuries so severe that they cause permanent damage and are unable to continue playing baseball.

Three new studies presented today at the at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS) address this critical issue, each offering new solutions to help prevent these injuries.

Five-minute stretch after play can help young players avoid throwing-arm pain

Pitchers and catchers under the age of 15 often experience tightness of a shoulder ligament known as the posterior-inferior glenohumeral ligament. If this ligament is not stretched, it will become increasingly tighter and more prone to pain or injury as the player ages, if that player continues to play baseball.

A study of 1,267 youth baseball players, led by Charles Metzger, MD, an orthopaedic surgeon specializing in upper extremities in Houston, Texas, found that a simple stretch known as the posterior capsular stretch can help.

"A posterior capsular stretch is done after play and since it is different from the general stretches players already know, it must be taught," says Dr. Metzger. "Once learned, however, it is very simple, and takes only five minutes to complete. Nearly 97 percent of young players who performed the stretch properly and consistently reported shoulder improvement."

Dr. Metzger supports Safe Throw, an injury-prevention and rapid return-to-play program. Instructions and diagrams showing how to perform the posterior capsular stretch can be found on www.safethrow.com.

Twenty-five percent of young players experience elbow pain; pitchers have highest rate of osteochondral lesions

The elbow is the most frequently reported area of overuse injury in child and adolescent baseball players. One type of overuse includes osteochondral lesions, which are tears or fractures in the cartilage and underlying bone, covering the elbow joint.

In a study led by Tetsuya Matsuura, MD, Department of Orthopedics, The University of Tokushima Graduate School, Institute of Health Bioscience in Tokushima, Japan, 152 baseball players were observed (ranging in age from 8 to12) for one season to study the injury incidence in relation to their playing positions. These players had no history of problematic elbow pain.

The results were as follows:

• 38 players, or 25 percent complained of elbow pain;
• of these 38 players, 26 (68.4 percent) had limitations of range of motion and/or tenderness on the elbow, and/or valgus stress pain (a stressful force placed upon the ligaments on the inner side of the elbow joint); and
• Of those 26 players, 22 (84.6 percent) had osteochondral lesions, including:
  • 12 pitchers (54.6 percent)
  • 6 catchers (27.3 percent)
  • 3 infielders (13.6 percent)
  • 1 outfielder (4.5 percent).

Dr. Matsuura concluded, "Twenty-five percent of child and adolescent baseball players have elbow pain and nearly 15 percent sustain osteochodral lesions per year and pitchers have the highest rate of osteochondral lesions. If overuse injuries such as osteochrondral lesions occur, prompt diagnosis and treatment can prevent this injury from causing long-term damage. Better awareness and education among parents, players and especially coaches about risk factors can help prevent these injuries."

Reviewing - and adhering to - youth baseball throwing guidelines can help prevent injury

In another presentation, led by George A. Paletta, Jr., MD, an orthopaedic surgeon at the Orthopedic Center of St. Louis and Medical Director/Head Team Physician of the St. Louis Cardinals, discussed the increase in elbow injuries of young baseball players, including the increasing number of ligament reconstruction or "Tommy John" procedures performed.

Despite these increases, Dr. Paletta says there are identifiable - and controllable - risk factors of which young athletes, parents and coaches should be aware, to help reduce injury.

"A young athlete should never throw through pain or continue to pitch when he or she is obviously fatigued," says Dr. Paletta. "Additionally, parents should familiarize themselves with the recommended single game, weekly and season total pitch counts, suggested recovery times, and recommended ages for learning various pitches."

Dr. Paletta stresses that there must be a greater focus on education and research in this area, or more young baseball players will sustain serious injury.