High elasticity of the flexor carpi ulnaris and pronator teres muscles is associated with medial elbow injuries in youth baseball players

Background: Pitch velocity is associated with elbow injuries among skillful baseball players. However, the relationship between pitch velocity and throwing elbow injuries among youth players has not yet been clarified. Purpose: To investigate the influence of pitch velocity on medial elbow pain and medial epicondyle abnormality among youth baseball players. Study Design: Cohort study; Level of evidence, 3. Methods: The participants consisted of 256 elementary school players (mean age, 11 ± 1 years; range, 9-12 years). The medial aspect of the elbow was evaluated using ultrasound imaging. A questionnaire was used to investigate past or present pain in the elbow, background of the players (age, height, body mass index, and years of baseball experience), and playing environment (number of days of practice in a week, experience as a pitcher, and cryotherapy of the shoulder and elbow after practice). Positioning of the scapula, range of motion in shoulder internal/external rotations and hip internal rotation, angle of the straight-leg raise, and heel-to-buttock distance were measured. The pitch velocity was recorded using a pitch velocity radar gun. The relationship between these variables and the presence of medial epicondyle abnormality, as well as past or present elbow pain, were statistically analyzed. Results: A medial epicondyle abnormality was observed in 130 players (51%), elbow pain in the past in 65 players (25%), and elbow pain during the examination in 14 players (5%). Sixty-nine players (27%) experienced elbow pain either in the past or during examination. Abnormality of the medial epicondyle had a relationship with the pitch velocity (odds ratio [OR], 1.1 for increase of 1 km/h; 95% CI, 1.1-1.2; P < .0001) and the number of practice days in a week (OR, 1.8 for increase of the practice days; 95% CI, 1.4-2.5; P < .0001). Pitch velocity was also significantly related with past pain, present pain, and past and/or present pain of the elbow (OR [km/h], 1.1, 1.1, 1.1; 95% CI, 1.0-1.1, 1.0-1.2, 1.1-1.2; P < .0001, P = .002, P < .0001, respectively). Conclusion: Pitch velocity was significantly associated with abnormality of the medial epicondyle and elbow pain. A 10-km/h increase in pitch velocity would increase the risk of medial epicondyle abnormality and medial elbow pain by 3 times.

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Increasing Burden of Youth Baseball Elbow Injuries in US Emergency Departments

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119845636 ◽

2019 ◽

Vol 7 (5) ◽

pp. 232596711984563 ◽

Cited By ~ 5

Author(s):

David P. Trofa ◽

Kyle K. Obana ◽

Hasani W. Swindell ◽

Brian Shiu ◽

Manish S. Noticewala ◽

...

Keyword(s):

Linear Regression Analysis ◽

Shoulder Injuries ◽

Injury Surveillance System ◽

Baseball Players ◽

Elbow Injury ◽

Youth Athletes ◽

Increased Risk ◽

Youth Baseball ◽

Elbow Injuries ◽

Over Time

Background: Youth athletes are starting sports earlier and training harder. Intense, year-round demands are encouraging early sports specialization under the perception that it will improve the odds of future elite performance. Unfortunately, there is growing evidence that early specialization is associated with increased risk of injury and burnout. This is especially true of pediatric and adolescent baseball players. Purpose/Hypothesis: The purpose of this investigation was to analyze national injury trends of youth baseball players. We hypothesized that while the total number of baseball injuries diagnosed over the past decade would decrease, there would be an increase in adolescent elbow injuries seen nationally. A further hypothesis was that this trend would be significantly greater than other injuries to the upper extremity and major joints. Study Design: Descriptive epidemiology study. Methods: Injury data from the National Electronic Injury Surveillance System, a United States Consumer Product Safety Commission database, were analyzed between January 1, 2006, and December 31, 2016, for baseball players aged ≤18 years. Data were collected on the location of injury, diagnosis, and mechanism of injury. Results: Between 2006 and 2016, an estimated 665,133 baseball injuries occurred nationally. The mean age of the injured players was 11.5 years. The most common injuries diagnosed included contusions (26.8%), fractures (23.6%), and strains and sprains (18.7%). Among major joints, the ankle (25.6%) was most commonly injured, followed by the knee (21.3%), wrist (19.2%), elbow (17.7%), and shoulder (16.2%). The incidence of the ankle, knee, wrist, and shoulder injuries decreased over time, while only the incidence of elbow injuries increased. A linear regression analysis demonstrated that the increasing incidence of elbow injuries was statistically significant against the decreasing trend for all baseball injury diagnoses, as well as ankle, knee, wrist, hand, and finger injuries ( P < .05). Additionally, the only elbow injury mechanism that increased substantially over time was throwing. Conclusion: The current investigation found that while the incidence of baseball injuries sustained by youth players is decreasing, elbow pathology is becoming more prevalent and is more commonly being caused by throwing. Given that the majority of elbow injuries among adolescent baseball players are overuse injuries, these findings underscore the importance of developing strategies to continue to ensure the safety of these youth athletes.

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Elbow Injuries in Youth Baseball Players Without Prior Elbow Pain

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967113509948 ◽

2013 ◽

Vol 1 (5) ◽

pp. 232596711350994 ◽

Cited By ~ 26

Author(s):

Tetsuya Matsuura ◽

Naoto Suzue ◽

Shinji Kashiwaguchi ◽

Kokichi Arisawa ◽

Natsuo Yasui

Keyword(s):

Baseball Players ◽

Elbow Pain ◽

Youth Baseball ◽

Elbow Injuries

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High Thoracic Kyphosis and Backward Trunk Inclination Angles in the Single-Leg Standing Position Associate With Medial Elbow Injuries in Youth Baseball Players: A Cross-Sectional Study

Journal of Sport Rehabilitation ◽

10.1123/jsr.2020-0155 ◽

2020 ◽

pp. 1-8

Author(s):

Akira Saito ◽

Kyoji Okada ◽

Hiromichi Sato ◽

Kazuyuki Shibata ◽

Tetsuaki Kamata

Keyword(s):

Thoracic Kyphosis ◽

Standing Position ◽

Baseball Players ◽

Elbow Injury ◽

Joint Range Of Motion ◽

Trunk Inclination ◽

Youth Baseball ◽

Elbow Injuries ◽

Inclination Angles ◽

Joint Range

Context: Baseball pitching is a coordinated movement involving the spine. A previous study indicated that increased thoracic kyphosis angle in a standing position was a risk factor for medial elbow injuries in youth baseball players. However, spinal alignments in single-leg standing and their relationships with medial elbow injuries, scapular alignment, or hip joint range of motion are unclear. Objective: To examine the difference in spinal alignment between standing and single-leg standing positions in youth baseball players and analyze their relationship with elbow injuries, scapular alignment, or hip joint range of motion. Design: Cross-sectional study. Setting: University laboratory. Participants: There were 51 youth baseball players with medial epicondylar fragmentation (medial elbow injury group) and 102 healthy youth baseball players (control group). Main Outcome Measures: Thoracic kyphosis, lumbar lordosis, and trunk inclination angles during standing and single-leg standing, forward scapular posture, and hip joint range of motion. Results: In the single-leg standing position, the thoracic kyphosis and backward trunk inclination angles were significantly higher in the medial elbow injury group than in the control group (P = .016 and P = .046, respectively). In the standing position, no significant difference was observed between both groups. The thoracic kyphosis angle in single-leg standing was positively correlated with the bilateral forward scapular posture in the medial elbow injury (P = .008 and P < .001 on the throwing and nonthrowing sides, respectively) and control (P = .010 and P = .032 on the throwing and nonthrowing sides, respectively) groups. Conclusions: High thoracic kyphosis and backward trunk inclination angles are characteristics during single-leg standing in youth baseball players with medial elbow injuries. Spinal alignment measurement in single-leg standing may be useful for identifying youth baseball players who are at risk for sustaining medial elbow injury.

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Efficacy of a Prevention Program for Medial Elbow Injuries in Youth Baseball Players

The American Journal of Sports Medicine ◽

10.1177/0363546517738003 ◽

2017 ◽

Vol 46 (2) ◽

pp. 460-469 ◽

Cited By ~ 15

Author(s):

Jun Sakata ◽

Emi Nakamura ◽

Tatsuhiro Suzuki ◽

Makoto Suzukawa ◽

Atsushi Akaike ◽

...

Keyword(s):

Physical Function ◽

Internal Rotation ◽

Prevention Program ◽

Thoracic Kyphosis ◽

Kyphosis Angle ◽

Baseball Players ◽

Elbow Injury ◽

Youth Baseball ◽

Elbow Injuries

Background: Youth baseball players are at high risk for elbow injuries, which can lead to future functional disability. Purpose: To evaluate the effectiveness of a prevention program to lower the risk of medial elbow injury in these athletes. Study Design: Cohort study; Level of evidence, 2. Methods: Youth baseball players, 8 to 11 years old, without a history of elbow and shoulder pain, were allocated to either the intervention (n = 136) or control (n = 169) group. The intervention consisted of 9 strengthening and 9 stretching exercises, performed during warm-up or at home, with high compliance defined as completion of the program 1 or more times per week. The following outcome variables were measured: clinical assessment of the elbow and shoulder joint, ultrasonography assessment of the elbow, and assessment of physical function (passive range of motion of the elbow, shoulder, and hip; strength of the shoulder and scapular muscles; and measurement of the thoracic kyphosis angle). The clinical and ultrasonography assessments were measured at baseline and at 3-month intervals over the 1-year follow-up. Physical function outcomes were measured at baseline and at the endpoint of the follow-up. The primary endpoint of effectiveness was the incidence of medial elbow injury. Secondary endpoints were absolute measures of physical function and change in these measures over the 1-year follow-up. Results: The incidence rate of medial elbow injury was significantly lower in the intervention group (0.8/1000 athlete-exposures) than the control group (1.7/1000 athlete-exposures) (hazard ratio, 50.8%; 95% CI, 0.292-0.882; P = .016). The program improved total range of shoulder rotation (dominant side), hip internal rotation (nondominant side), shoulder internal rotation deficit (bilaterally), lower trapezius muscle strength (dominant side), and the thoracic kyphosis angle. Improvements in the following variables of physical function were predictive of a lower rate of medial elbow injury: increased total shoulder total rotation (odds ratio [OR], 0.973; 95% CI, 0.950-0.997), increased hip internal rotation of the nondominant side (OR, 0.962; 95% CI, 0.936-0.989), and decreased thoracic kyphosis angle (OR, 1.058; 95% CI, 1.015-1.103). Conclusion: A prevention program aiming to improve physical function can prevent medial elbow injury in youth baseball players.

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Asymptomatic Medial Elbow Ultrasound Abnormality in Youth Baseball Players Is an Independent Risk Factor for Elbow Injury: A Prospective Cohort Study

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120986791 ◽

2021 ◽

Vol 9 (4) ◽

pp. 232596712098679

Author(s):

Hitoshi Shitara ◽

Tsuyoshi Tajika ◽

Takuro Kuboi ◽

Tsuyoshi Ichinose ◽

Tsuyoshi Sasaki ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Cohort Study ◽

External Rotation ◽

Medial Epicondyle ◽

Baseball Players ◽

Elbow Pain ◽

Elbow Injury ◽

Youth Baseball ◽

Elbow Injuries

Background: Youth baseball players who experience elbow pain during the season frequently exhibit radiographic elbow abnormalities. However, it is unknown whether asymptomatic elbow abnormalities are risk factors for in-season elbow injuries. Purpose: To determine whether the preseason presence of asymptomatic medial epicondyle apophysitis is a risk factor for in-season elbow injuries in youth baseball players. Study Design: Cohort study; Level of evidence, 2. Methods: Youth baseball players (N = 210; age range, 7-12 years) with no pain or history of injury in their throwing arms underwent preseason evaluations that included shoulder and elbow range of motion measurements, shoulder muscle strength testing, and ultrasound elbow scans with a multifrequency 13-MHz linear array transducer. Over 1 year of play, the players and their parents maintained daily elbow pain diaries. Elbow injuries were defined as medial elbow symptoms that prevented ball throwing for ≥8 days. Results: The preseason ultrasound evaluation revealed medial epicondyle apophysitis in 59 players. In the year following, elbow injuries occurred in 17 (28.8%) players with preseason medial epicondyle apophysitis and 18 (11.9%) players without apophysitis. Independent predictors of elbow injuries were preseason medial epicondyle apophysitis (odds ratio [OR], 2.488; 95% confidence interval [CI], 1.152-5.376; P = .02) and deficits of abduction (ABD) and external rotation of the dominant shoulder (OR, 0.963; 95% CI, 0.936-0.992; P = .012). Conclusion: Asymptomatic medial epicondyle apophysitis and ABD and external rotation deficits in the dominant shoulder were risk factors for elbow injuries in 7- to 12-year-old youth baseball players. These findings may aid in the design of programs to prevent elbow injuries in this population.

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Throwing Injuries in Youth Baseball Players: Can a Prevention Program Help? A Randomized Controlled Trial

The American Journal of Sports Medicine ◽

10.1177/0363546519861378 ◽

2019 ◽

Vol 47 (11) ◽

pp. 2709-2716 ◽

Cited By ~ 4

Author(s):

Jun Sakata ◽

Emi Nakamura ◽

Tatsuhiro Suzuki ◽

Makoto Suzukawa ◽

Masaki Akeda ◽

...

Keyword(s):

Prevention Program ◽

Thoracic Kyphosis ◽

Controlled Trial ◽

Intervention Group ◽

Control Group ◽

Baseball Players ◽

Ball Speed ◽

Randomized Controlled ◽

Youth Baseball ◽

Elbow Injuries

Background: Throwing injuries of the shoulder and elbow are common among youth baseball players. Hypothesis: A prevention program will reduce the incidence of throwing injuries of the shoulder and elbow by 50% among youth baseball players. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: The authors block randomized 16 youth baseball teams consisting of 237 players aged 9 to 11 years into an intervention group (8 teams, 117 players) and a control group (8 teams, 120 players). The intervention program consisted of 5 stretching, 2 dynamic mobility, and 2 balance training exercises performed during warm-up. Both groups were followed up for 12 months, during which the incidence of shoulder and elbow injuries was recorded. In addition, ball speed during pitching as a performance-related factor and variables of physical function (passive range of motion of the elbow, shoulder and hip, dynamic balance, and thoracic kyphosis angle) were assessed during the pre- and postintervention periods. Results: The incidence of shoulder and elbow injuries in the intervention group (1.7 per 1000 athlete-exposures) was significantly lower than that in the control group (3.1 per 1000 athlete-exposures) (hazard ratio, 1.940; 95% CI, 1.175-3.205; P = .010). The factors related to pitching performance, as assessed by ball speed, tended to increase in the intervention group as compared with the control group ( P = .010). The program also improved shoulder horizontal adduction deficits on the dominant side, hip internal rotation on the nondominant side, and the thoracic kyphosis angle. Conclusion: A prevention program decreases throwing injuries of the shoulder and elbow and enhances the parameter of pitching performance in youth baseball players.

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