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Risk assessment and prevention of arm injuries in baseball players: a working knowledge is critical to physicians who are directly involved.

Article Excerpt
Although baseball is considered a generally safe sport, young pitchers often experience arm injuries. The repetitive nature of pitching makes the throwing arm susceptible to injury, particularly the elbow and shoulder. (1) Microtrauma to soft tissue often is either without symptoms or mild, merely resulting in temporary pain and soreness. With continued stress, however, microtrauma may accumulate, thus increasing the probability of a serious injury.

This problem can best be illustrated when its scope is placed in perspective. There are more than 12 million amateur baseball players, mostly children and adolescents, according to USA Baseball. (2) Perhaps the most recognizable youth baseball organization, Little League Inc, oversaw 2.6 million players during the 2006 season. (3) Nearly one-fourth of youth baseball players are estimated to participate as pitchers, translating into millions of young pitchers.

The enormous number of children and young adults who are at high risk for throwing arm injuries highlights the importance of prevention and treatment. A working knowledge of the risks is critical to physicians who are directly involved with these players, as well as parents and coaches, to keep them healthy and able to participate. In this article, we describe the main risk factors for throwing injuries in young athletes and ways to minimize and prevent these injuries.

RISK FACTORS

In a 2001 survey of Little League pitchers, 26% experienced elbow pain during the season and 32% had an episode of shoulder pain. (4) Arm fatigue during the game was a risk factor for pain in both the shoulder and elbow. Throwing more than 75 pitches in the game was a shoulder-specific risk factor; pitching on an additional team and weight lifting during the season were risk factors for elbow pain.

An odds ratio for injury is provided by a 2006 follow-up study that compared injured adolescent pitchers with uninjured controls. (5) Pitching in more than 8 months of the year, throwing more than 80 pitches in a game, and pitching with fatigue increased the risk of a shoulder or elbow injury more than 3-fold. (5) Official USA Baseball recommendations have been based on studies such as these.

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Pitching on a mound places more stress on the arm than pitching on flat ground. (6) Basically, young athletes pitch too much and do not throw enough. Pitching involves the increased force of gravity when the pitcher strides off the mound and includes maximal stride length and rotational torques on the shoulder and elbow; throwing on flat ground does not place the same stresses on the arm. Therefore, year-round throwing is acceptable because it facilitates endurance, adaptation, and accommodation to the movement. However, year-round pitching is not acceptable because it...

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