Upper Extremity Physeal Injury in Young Baseball Pitchers

Published by: Bryan M. Saltzman, MD; Peter N. Chalmers, MD; Randy Mascarenhas, MD, FRCSC; Brian J. Cole, MD, MBA; and Anthony A. Romeo, MD in The Physician and Sportsmedicine

Abstract: Adolescent baseball players, especially pitchers, are at increased risk for
shoulder and elbow injuries as their level of competition increases. The intersection of
the adolescent growth spurt with the high levels of elbow valgus and shoulder rotational torques placed upon the arm during overhand pitching predisposes the shoulder and elbow to physeal injuries. Little League shoulder and Little League elbow syndromes most commonly represent pathology at the physeal regions of the proximal and distal humerus and proximal ulna sustained from repetitive loads caused by overhead throwing.

There is a growing understanding that these injuries occur on a wide spectrum from delayed physeal closure and physeal widening to acute transphyseal fracture. Although operative intervention is infrequently required, patient and parent counseling can be complex. Health care professionals who care for adolescent baseball players also can play an important role in prevention. Appropriate counseling requires a comprehensive understanding of the clinical, radiographic, and biomechanical aspects of these injuries. This review summarizes these major concepts, focusing on the best available evidence from recent biomechanical and clinical studies on shoulder and elbow injuries in adolescent baseball pitchers.

Introduction: Adolescent baseball players, specifically pitchers, are at an increased risk for shoulder and elbow injuries as skill and level of competition increases. Little League shoulder and Little League elbow are conditions that commonly represent physeal pathology of the proximal and distal humerus and proximal ulna sustained from the repetitive valgus and rotational loads inherent to overhead throwing. The concomitant adolescent growth spurt1 and the increasing athletic demand on these young players lead to a spectrum of upper extremity injury from delayed physeal closure or physeal widening to acute transphyseal fracture.

Health care professionals who care for adolescent baseball players play an important part in patient, parent, and coach counseling to prevent what can be an avoidable condition. It is important to comprehend the various clinical, biomechanical, and radiologic facets of physeal injuries in youth baseball players, and this review summarizes the best available evidence from recent published literature on the topic.

READ THE COMPLETE ARTICLE

Basic Anatomy of the Adolescent Elbow; Basic Anatomy of the Adolescent
Shoulder; Basic Biomechanics of the Overhead Throwing Motion; Phases of the Pitching Motion; Injury Types and Pathomechanics as a Function of Pitching Motion; Common Injuries Sustained in Adolescent Overhead Throwing
Athletes; Little League Shoulder and Elbow: Clinical Workup; Eliciting a History From the Adolescent Overhead Throwing Patient; Physical Examination of the Adolescent Elbow; Physical Examination of the Adolescent Shoulder; Radiographic Assessment of the Elbow; Radiographic Assessment of the Shoulder; Clinical Studies on Little League Elbow Injury; Clinical Studies on Little League Shoulder Injury; Comparison of Adult and Adolescent Throwers; Prevention Strategies.