Download Overuse Elbow Injuries in the Young Athlete

Overuse Elbow Injuries
in the Young Athlete
Aaron Provance, MD
No financial disclosures
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Objectives
• Background
• Review common overuse elbow
injuries of the young athlete
• PT
• Prevention
• New CHSAA Bylaws
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Epidemic
• Dr. Andrews has recently called overuse injuries of the elbow
in youth pitchers an epidemic
• 5% of youth pitchers suffer a serious elbow or shoulder injury
requiring surgery or retirement from sport within 10 years of
play
• Increasing number of Tommy John (UCL reconstruction)
surgeries are performed every year
• Much research on this topic identifying risk factors for these
injuries
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Pathophysiology
• Chronic repetitious injury from throwing mechanism
• Continued play and throwing despite significant pain
in the elbow
• Pitch counts may not be tracked by the team
• Poor pitching mechanics can contribute to the
mechanism of injury
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Risk Factors
• Number of pitches
• Pre-existing pain
• Year round play without
rest
• Side arm throwing
• Multiple teams / Travel
teams
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Overuse Injury/
Growth Concerns
• Microtrauma from submaximal loads
• Inflammatory response
• Most growth plate injures heal without complications
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Common Causes of Elbow Pain in
Young Athletes
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•
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•
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Panner’s Disease
Osteochondritis Dessicans
Ulnar Collateral Ligament Injury
Medial Epicondyle Apophysitis
Medial Epicondylitis
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Panner’s Disease
• Fragmentation, irregular ossification of
capitellum
• Caused by avascular necrosis from chronic
repetitive trauma
• Self limiting process; regeneration and
recalcification
• Ages 6-10 years
• Hx of lateral elbow pain aggravated with
activity
• Focal tenderness over capitellum, may
have effusion, limited extension typical
(20-30° lag)
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Osteochondritis Dessicans
• Fragmentation of bone and
overlying cartilage of capitellum or
radial head
• Chronic lateral compression stress
associated with throwing sports
• Ages 10-16 years
• Lateral elbow pain
worst with activity, swelling,
mechanical symptoms,
loss of ROM
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Ulnar Collateral Ligament Injury
• Excessive valgus forces on
medial compartment of elbow
• Late cocking/early
acceleration phase
of throwing
• Acute rupture or chronic
inflammation leading to
microscopic tears
• Medial elbow pain worse
with throwing
https://www.arthrex.com
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Medial Epicondyle
Apophysitis
• Traction apophysitis of
medial epicondyle
• Repetitive overuse, valgus
overload
• Tenderness over medial
epicondyle, pain with resisted
flexion and pronation
• Typical age: 10-15 yrs
• Medial elbow pain worse
with throwing activity
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Medial Epicondylitis
• Overuse injury of
flexor/pronator muscles
originating at medial
epicondyle
• Older adolescent with fused
medial epicondyle apophysis
• Medial elbow pain,
worse with activity
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Proper PT
• Addressing rotator cuff weakness, scapular stabilizer
weakness, core strength and scapular dyskinesia
• Proper pitching biomechanics
• Pitching, throwing and practice drills are vital for a young
pitcher to develop the coordination, strength, flexibility,
endurance, mentality and skills necessary for success
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Prevention – Pitch Counts
Age
•
17-18
105 pitches per day
•
13-16
95 pitches per day
•
11-12
85 pitches per day
•
9-10
75 pitches per day
•
7-8
50 pitches per day
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Prevention
• Young pitchers should not be allowed to throw as hard as they
can until they demonstrate mature throwing mechanics
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Prevention
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Governing State HS Associations
• Most of the State High School Associations’ bylaws do not
reflect the current research in the medical journals
• Need significant changes in rules, perceptions and most
importantly the CULTURE of youth baseball!
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CHSAA Baseball
• CHSAA (Colorado High School Activities Association) previous
throwing bylaws:
– “A pitcher may appear in no more than 12 innings in any
three consecutive calendar days.”
– “A pitcher may not appear in more than 70 innings,
exclusive of district, regional or state playoffs games during
the season.”
– Violation results in playing being ineligible = team forfeits
the game
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New Bylaws
• Based on current medical
literature/recommendations
• Focus on pitch counts
• Pitches thrown in innings vary
significantly
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New Bylaws
• New pitching limits for varsity and junior varsity – GO TO
CHSAANOW
• If a pitcher reaches or exceeds the pitch limit, this will
result in one day of mandated rest
• Any school not entering the information within the
mandated timeframe will be placed on restriction from
the playoffs
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New Bylaws
• Pitchers should not be throwing through pain, fatigue or
decreased accuracy
• Players are discouraged not to play pitcher and catcher
positions in the same game
• Production of an educational video including risk factors,
proper pitching techniques and when to be evaluated by
a medical professional
https://www.youtube.com/watch?v=yNwaZfWM5bo
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Conclusion
• Proper treatment, education on overuse injuries, and
prevention is the key to decreasing the incidence
• Pitch counts and proper mechanics
• Spread the word about STOPsportsinjuries.org
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