GREENWICH, Conn. -- In the past ten years, injuries in young athletes have been on the rise. For youth involved in repetitive throwing activities, there is an epidemic of elbow and shoulder injuries, usually due to overuse, poor training, improper throwing mechanics, and fatigue.
Injury to the ulnar collateral ligament (UCL) is the most dreaded condition and is usually caused by excessive pitching. If the UCL is injured, it can sometimes be difficult to repair or rehabilitate and may require the so-called Tommy John procedure in order to return to competitive pitching. The surgery is named after Tommy John, the first baseball pitcher to undergo successful UCL reconstruction surgery in the 1970's.
Other common throwing-related injuries include Little League shoulder, which occurs when the growth plate of the humerus (arm bone) becomes inflamed by the excessive forces produced by repetitive throwing. Similarly, Little League elbow involves injury to the growth plate along the inner portion of the elbow.
In addition to acute injuries, repetitive activities such as throwing can lead to physical changes in the development of growing bones and joints. It has been known for some time now that significant amounts of pitching during adolescence can change the rotation and shape of the shoulder which may leave the player vulnerable to shoulder injury and arthritis in adulthood.
Studies show that children and adolescents who pitch competitively for more than 8 months in a year are the most prone to injury. Throwing more than 80 pitches per game, a fastball that consistently exceeds 85 mph, or pitching while fatigued are also risk factors for injury.
According to one study, pitchers who pitched more than 100 innings in a calendar year were 3.5 times more likely to sustain serious injuries requiring elbow or shoulder surgery or retire due to the injury. This is why USA Baseball and Major League Baseball now recommend that youth pitchers of all ages and abilities take a minimum four month break from overhead throwing, with at least two months off consecutively.
However, athletes and their parents should be reassured that numerous studies have shown that kids who are exposed to a range of sports that utilize different muscle groups and mechanical skills have greater overall success in athletics than those who specialize early on. In addition, they are less prone to injury and burnout than those who focus on a single sport exclusively.
Demetris Delos, MD, is an orthopedic surgeon at Orthopaedic and Neurosurgery Specialists (ONS) in Greenwich and Stamford, who specializes in Sports Medicine and conditions of the knee and shoulder.