Tommy John Surgery — 80% Mental Blog

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 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.

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.

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
* 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
* 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.

Source: American Academy of Orthopaedic Surgeons

See also: Kids' Baseball Injuries Down But Some Still Play "Until It Hurts" and Baseball Brains - Pitching Into The World Series

At a recent baseball game, the 12-year-old second baseman on my son's team had a ground ball take a nasty hop, hitting him just next to his right eye. He was down on the field for several minutes and was later diagnosed at the hospital with a concussion.

Thankfully, acute baseball injuries like this are on the decline, according to a new report. However, several leading physicians say overuse injuries of young players caused by too much baseball show no signs of slowing down.

Our unlucky infielder's hospital injury report may become part of a national database called the National Electronic Injury Surveillance System (NEISS), part of the U.S. Consumer Product Safety Commission. It monitors 98 hospitals across the country for reports on all types of injuries.

Bradley Lawson, Dawn Comstock and Gary Smith of Ohio State University filtered this data to find just baseball-related injuries to kids under 18 from 1994-2006.

During that period, they found that more than 1.5 million young players were treated in hospital emergency rooms, with the most common injury being, you guessed it, being hit by the ball, and typically in the face.

The good news is that the annual number of baseball injuries has decreased by 24.9 percent over those 13 years. The researchers credit the decline to the increased use of protective equipment.

"Safety equipment such as age-appropriate breakaway bases, helmets with properly-fitted face shields, mouth guards and reduced-impact safety baseballs have all been shown to reduce injuries," Smith said. "As more youth leagues, coaches and parents ensure the use of these types of safety equipment in both practices and games, the number of baseball-related injuries should continue to decrease. Mouth guards, in particular, should be more widely used in youth baseball."

Their research is detailed in the latest edition of the journal Pediatrics.

The bad news is ...

While accident-related injuries are down, preventable injuries from overuse still seem to be a problem, according to author Mark Hyman. In his recent book, "Until It Hurts," Hyman admits his own mistakes in pressuring his 14-year-old son to continue pitching with a sore arm, causing further injury.

Surprised by his own unwillingness to listen to reason, Hyman, a long-time journalist, researched the growing trend of high-pressure parents pushing their young athletes too far, too fast.

"Many of the physicians I spoke with told me of a spike in overuse injuries they had witnessed," Hyman told Livescience. "As youth sports become increasingly competitive — climbing a ladder to elite teams, college scholarships, parental prestige and so on — children are engaging in a range of risky behaviors."

One expert he consulted was Dr. Lyle Micheli, founder of one of the country's first pediatric sports medicine clinics at Children's Hospital in Boston. Micheli estimates that 75 percent of the young patients he sees are suffering from some sort of overuse injury, versus 20 percent back in the 1990s.

"As a medical society, we've been pretty ineffective dealing with this," Micheli said. "Nothing seems to be working."

Young surgeries

In severe overuse cases for baseball pitchers, the end result may be ulnar collateral ligament surgery, better known as "Tommy John" surgery. Dr. James Andrews, known for performing this surgery on many professional players, has noticed an alarming trend in his practice. Andrews told The Oregonian last month that more than one-quarter of his 853 patients in the past six years were at the high school level or younger, including one 7-year-old.

Last spring, Andrews and his colleagues conducted a study comparing 95 high-school pitchers who required surgical repair of either their elbow or shoulder with 45 pitchers that did not suffer injury.

They found that those who pitched for more than eight months per year were 500 percent more likely to be injured, while those who pitched more than 80 pitches per game increased their injury risk by 400 percent. Pitchers who continued pitching despite having arm fatigue were an incredible 3,600 percent more likely to do serious damage to their arm.

Hyman encourages parents to keep youth sports in perspective. "I think that, generally, parents view sports as a healthy and wholesome activity. That's a positive. But, we live in hyper-competitive culture, and parents like to see their kids competing," he said. "It's not only sports. It's ballet and violin and SAT scores and a host of other things. It's in our DNA."

Please visit my other sports science articles at Livescience.com.