It’s Spring time and that means baseball season is here! Our allegiance to our favorite teams are deep rooted and something many people who have never played the game show great passion for. I run into countless patients who seem to wear only clothes emblazoned with their favorite ball team. I have very fond memories of playing baseball in my youth - it was a time of fun, competition, and friends.
Baseball is taking a new role in my life as I have three sons who are starting their baseball careers, as many young kids do. Pee wee baseball introduces the concepts of throwing, catching, hitting, and being safe vs. out. The years that follow quickly introduce concepts of double plays, run downs, pitching and all the intricate challenges baseball presents. Its an addicting game appropriately labeled as America’s favorite past-time!
However, I look at the game and these young athletes with a different perspective now. As an orthopedic surgeon who focuses on the shoulder, I see injuries as a result of this game we love. A number of injuries can occur during routine athletics, but I’ll focus on the ones unique to the throwing athlete. The young thrower is at risk of overuse injuries of the shoulder and elbow as a result of repetitive throwing.
The act of throwing is a complex sequence of events that requires range of motion of the shoulder and elbow. Balanced muscles of the shoulder girdle are important to prevent injuries. As the throwing athlete progresses, adaptations in range of motion puts the athlete at a higher risk of elbow or shoulder injuries.
It’s very important to understand that the young athlete is skeletally immature - they are incomplete. In the young athlete (<16 for males and <14 for females), the growth plates are still open. What’s important to keep in mind is that the weakest portion of the skeletally immature athlete is the growth plates rather than a tendon, ligament or muscle. I will see young athletes whose parents thought it was a sprain or strain. Weeks or months go by and the athlete hasn’t recovered. Many times it is an injury to the growth plate (physis) that needs to be treated differently.
Little League Shoulder is an overuse injury of micro trauma to the proximal humeral growth plate. X-rays can show widening of the growth plate. Pitchers age 11-14 years are most commonly injured. It is managed with 3 months of rest from throwing. The best medicine is prevention. It is important for parents and coaches to be compliant with pitch counts as recommended by USA baseball. If the young athlete is on multiple teams, pitch counts need to be tracked across teams to minimize overuse injuries.
Little League Elbow is an overuse injury of the medial epicondyle (medial apophysitis). This area is still growing and not yet fused, again causing it to be the weakest link in the kinetic chain. During the throwing motion, a significant force is placed across the medial elbow. The tendinous origins of the flexor-pronator mass is pulling directly on the bony prominence of the medial elbow. This can cause considerable pain and inability to throw with normal velocity given the nature of the injury.
SLAP tears can occur more commonly in the adolescent athlete usually after skeletal maturity. This involves the superior labrum. SLAP stands for Superior Labrum Anterior to Posterior. This is common in overhead throwers. With the arm in full external rotation, the long head of the biceps can peel back the labrum. Pitchers with this injury can notice a sudden loss of velocity. SLAP tears can be treated with conservative treatment of physical therapy and muscular retraining, depending on the position they play. However, in those athletes that throw the most (pitchers and quarterbacks) it is common for surgical treatment to be required. SLAP lesions can be treated arthroscopically (minimally invasive poke hole surgery).
Rotator cuff tears can also occur in throwing athletes usually after skeletal maturity. Rotator cuff tears can be classified as full thickness or partial thickness. In the throwing athlete, partial thickness tears are more common. In the aging athlete, rotator cuff tears are extremely common. As we age, the incidence of rotator cuff tears increases. It is important to note that not all rotator cuff tears are the same. It is our goal to try conservative treatment first. Injections and physical therapy can alleviate symptoms and restore the shoulder in many cases. Certain large tears, traumatic tears, and those that are refractory to conservative measures may require surgical treatment.
The shoulder is an amazingly complex joint requiring the interplay of muscles, tendons, ligaments. The coordination between all structures for stability, all at the same time, allowing maximum range of motion and strength, makes the shoulder fascinating. Our team of experts in shoulder injuries and treatments can help guide you or your young athlete through the appropriate steps to alleviate pain and restore function. It is our goal to help prevent future injuries, as well. As parents, we love to see the joy in our kids faces playing sports. As orthopedic surgeons who focus on shoulder issues, it is our passion to help fix shoulder problems to allow all of us (big or little) to do the things we enjoy.
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