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Elbow Injuries in Baseball
Whitesidej A, Andrews JR and Fleisig GS.
ThePhysician and Sportsmedicine. 1999;27(6):87-92,

Skeletally immature athletes who throw repeatedly are at risk for elbow injuries that threaten the growth plate. Prevention and treatment of these injuries must take into account not only the number of pitches or throws and how often the athlete plays, but also velocity, throwing mechanics and the player's age.

Overhand throwing subjects the elbow to forces of tension, compression, shear and torsion. Typically, these repetitive excessive forces involve the hypertrophic zone of the growth plate, which is particularly vulnerable during peak growth velocity - ages 10 to 12 years for girls and ages 13 to 15 years for boys, according to the authors.

A typical history may reveal the patient has persistent medial elbow soreness, stiffness and discomfort that impair throwing and batting performance.

Physical exam findings may include medial tenderness when the ulnar collateral ligament is placed in a valgus stretch; diffuse medial pain or discomfort during palpation of the flexor-pronator muscle mass on the volar aspect of the proximal forearm; and minimal swelling of the forearm and pain with resisted pronation. X-rays should be taken to confirm the diagnosis and extent of osseous injury.

Nonsurgical treatment of players who have separation of the medial apophysis of less than 3 mm involves stopping play, icing the medial elbow, taking anti-inflammatory medication and starting a rehabilitation program that includes stretching, strengthening and sport specific activities.

If treatment fails, surgery usually involves pinning the medial apophysis if separation is greater than 3 mm and wiring if avulsion of the triceps- olecranon complex is significant.

To prevent injuries, athletes should stretch and condition daffy. Young players should undertake a strength training program designed for their age and ability before beginning a formal throwing program. They also should use age guidelines for learning new pitches and limit the number of pitches (See chart).


Amount of pitching:
Age       Max pitches/game    Max games/week
8-10        52 +or- 15                  2   +or-  0.6
11-12 68 +/- 18                          same
13-14 76 +/- 16                          same
15-16 91 +/- 16                          same
17-18 106 +/- 16                  same

Minimum age for learning pitches:
age +/- 2yr pitch
8                 fastball
10                 change-up
14                 curveball
15                 knuckleball
16                 slider
16                 forkball
17                 screwball