Elbow Injuries in Young Baseball Players

Abstract & Commentary

Synopsis: Young throwers should limit their pitches to prevent overuse elbow injuries.

Source: Whiteside JA, et al. Elbow injuries in young baseball players. Phys Sports Med 1999;27(6):87-92,102.

This article by whiteside and colleagues reminds us that growing bones are at risk of overuse injuries if subjected to too much, too hard, too soon. They report an incidence of injury in 12-year-old pitchers of 40%. Unlike adults, elbows of skeletally immature athletes, when subjected to repetitive valgus stress, do not sustain chronic or acute ulnar collateral ligament (UCL) injuries but instead may partially or completely avulse the medial apophysis attachment of the UCL.

The same mechanisms also produce compressive loads to the radial side of the elbow (the radial capitellar joint), resulting in abnormalities of the subchondral bone and overlying articular cartilage. Panner’s disease—osteochondrosis of the capitellum—occurs in younger children (7- to 11-year-olds) and typically heals if the player rests from throwing activities. True osteochondritis dissecans (OCD), which occurs in the slightly older child, may not resolve completely but instead results in separation of the osteochondral fragment, necessitating surgical intervention.

Not only do Whiteside et al detail the most common elbow injuries in young children, but their article also contains guidelines for diagnosing, treating, and rehabilitating injuries that occur in the young pitcher’s elbow. The importance of prevention is also stressed, and Whiteside et al present their recommendations for the maximum pitches that should be thrown by youngsters at various ages. For example, 8-10-year-olds should throw no more than 52 ± 15 pitches per game, whereas a 15-16-year-old should pitch no more than 91 ± 16 pitches per game. All of the age groups were limited to roughly 2 ± 0.6 games per week. Whiteside et al also suggest that youngsters should not begin pitching until age 8, at which time they should start with pitching fastballs, progressing to change-up pitches at age 10, and then to curves, knuckleballs, sliders, and forkballs. The screwball should be the last pitch learned and should not be attempted until age 17.

Comment by Letha Y. Griffin, MD, phd

An estimated 3 million* youngsters participate in Little League baseball each year and another 400,000* are involved in T-Ball. (*Source: American Academy of Orthopaedic Surgeons.) The benefits of sports participation are many and include increased physical fitness, increased socialization skills, and positive self-image. However, this article stresses what we have all witnessed in our practices. During the last several decades there has been a rise in not only acute injuries but also in overuse sports injuries. Kids are participating in organized sports at higher levels of competition at earlier ages. No more is baseball a sandlot pickup game where you go home when you’re tired. Now children play with real or perceived pressure from coaches, parents, siblings, and friends. They hesitate to say they are hurt and, as Whiteside et al stress, may try to work through pain until their performance is hampered.

Whiteside et al rightly suggest that coaches of youth baseball must not only know the fundamentals of baseball but must teach the proper mechanics of pitching and throwing to their young players. They also comment that parents should ensure that young players are not required to throw excessively. However, parents, even those with excellent intentions, frequently become preoccupied with the child’s potential abilities and are more supporters of increased pitching efforts rather than increased bench time for their youngsters.

The first pitch youngsters should master is the:

a. curve ball.

b. slider.

c. fastball.

d. change-up.

e. screwball.