Sports Trauma and Overuse STOP Elbow Injuries Prevention

Sports Trauma and Overuse STOP Elbow Injuries Prevention Catherine M. Robertson, MD UCSD Orthopaedic Surgery

Elbow Injuries • Why are we so concerned about elbow injuries? • Because elbow injuries are… – Common: >50 -75% of youth baseball players – Increasing: Elbow surgery has increased 50% in high school pitchers in the past 5 years. – Preventable: Fewer pitches = Longer Career • Only 4 Little League World Series pitchers have made it to the MLB • Why? Overuse injuries & Early burnout!

Common Elbow Conditions • Ligament & Tendon Injuries – UCL (Ulnar Collateral Ligament) • Tommy John – Medial & Lateral Epicondylitis • Bone & Growth Plate Injuries – Occur in Growing children – Medial Apophysitis • “Little Leaguer’s Elbow”

Risk Factors for Elbow Injuries • Number of Pitches – Pitch Count: #1 Risk Factor for Elbow Injuries – Year round baseball, Multiple teams • Pitch Types – Fast Ball should be mastered first – ? Breaking pitches should be taught later (>14 yrs) • Mechanics – Strength supports form, form supports speed – Fatigue leads to poor mechanics -Lyman, AJSM 2002

Pitch Counts & Rest Pitch Counts Age Pitches/Ga me 7 -8 50 9 -10 75 11 -12 85 13 -16 95 17 -18 105 Rest Days Age 7 - Age 1716 18 61+ 76+ 41 -60 51 -75 21 -40 26 -50 1 -25 -USA Baseball Medical and Safety Advisory Committee # Rest Days 3 2 1 0

When To Throw What • Fastball First • Change-up Second • Breaking Pitches – Curveball, Slider – After age 14? • Learn one pitch at a time Pitch Fastball Change-up Curveball Knuckleball Slider Forkball Screwball -USA Baseball Medical and Safety Advisory Committee Age 8± 2 10± 3 14± 2 15± 3 16± 2 17± 2

Diagnosing Elbow Overuse • Pain is NOT a sign of a strength deficit. • Common Symptoms – Loss of form, accuracy, or velocity – Takes longer to loosen up – Early Fatigue – Pain – Stiffness – Swelling -USA Baseball Medical and Safety Advisory Committee

Treating Elbow Overuse • Prevention is the best treatment! • Initial Treatment – Rest, Ice, Gentle stretching • Involve your coach early • When to see a doctor… – Pain that lasts more than a few days – Swelling or stiffness in the joint

Preventing Elbow Injuries Watch pitch counts and rest days! Always warm up & cool down Learn proper mechanics Don’t forget strength & conditioning • No year round play • Avoid multiple teams • Don’t pitch through pain or fatigue • •

Summary • Elbow injuries are common & preventable. • Pitch counts are the #1 risk factor for elbow injuries. • Prevention is the key and rest is the cure. • Charles Carroll • AOSSM Young Pitchers Project – www. surveymonkey. com/s/pitching