Shoulder and Elbow Injuries in High School Softball and Baseball Players: Letter to the Editor

Background: Shoulder and elbow injuries are major problems in baseball players. Tightness of the upper extremities has been reported as a risk factor for shoulder and elbow injuries in elementary and junior high school baseball players. However, few studies have been conducted on the relationship between decreased hip range of motion (ROM) and shoulder and elbow injuries. Purpose/Hypothesis: This study aimed to prospectively examine the relationship between hip ROM and throwing-related shoulder and elbow injuries in elementary and junior high school baseball players. The hypothesis was that players with unrestricted ROM in the hip would have a reduced risk of upper extremity injuries. Methods: The study included 263 baseball players (mean ± SD age, 10.5 ± 1.3 years; range, 7-14 years). The following physical parameters were assessed: (1) hip flexion ROM measured in the supine position and (2) hip internal and external rotation in the prone position. After the season, players completed questionnaires regarding shoulder and/or elbow injuries. For comparison, the players were classified as injured (not able to play for ≥8 days because of shoulder and/or elbow problems) or noninjured. Results: During the season, 52 players had shoulder and/or elbow injuries. When the injured and noninjured groups were compared, hip flexion on the dominant side (121.5° ± 12.0° vs 126.7° ± 9.8°, respectively; P < .01), hip flexion on the nondominant side (119.6° ± 11.7° vs 126.0° ± 9.9°, respectively; P < .01), and internal rotation on the dominant side (52.5° ± 11.3° vs 56.8° ± 10.8°, respectively; P = .01) were significantly reduced in the injured group. Conclusion: We identified preseason decreases in flexion bilaterally and internal rotation on the dominant side as risk factors for shoulder and elbow injuries in elementary and junior high school baseball players. Further studies are required to prevent disabilities in elementary and junior high school baseball players through development of prevention and intervention programs.

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Epidemiology of Shoulder and Elbow Injuries Among United States High School Baseball Players: School Years 2005-2006 Through 2014-2015

The American Journal of Sports Medicine ◽

10.1177/0363546517734172 ◽

2017 ◽

Vol 46 (1) ◽

pp. 37-43 ◽

Cited By ~ 28

Author(s):

Michael G. Saper ◽

Lauren A. Pierpoint ◽

Wei Liu ◽

R. Dawn Comstock ◽

John D. Polousky ◽

...

Keyword(s):

United States ◽

High School ◽

Injury Prevention ◽

Rate Ratio ◽

Injury Rate ◽

Injury Surveillance ◽

Shoulder Injuries ◽

Baseball Players ◽

Elbow Injury ◽

Elbow Injuries

Background: Shoulder and elbow injuries are common in young athletes, especially high school baseball players. Understanding the risk factors associated with baseball injuries is an essential first step in the development of injury prevention strategies. Purpose: To provide a comprehensive understanding of the epidemiology of shoulder and elbow injuries among high school baseball players in the United States. Study Design: Descriptive epidemiological study. Methods: Baseball-related injury data were obtained from the National High School Sports-Related Injury Surveillance Study using High School RIO (Reporting Information Online), an Internet-based sports injury surveillance system. Athletic trainers from high schools across the country uploaded data regarding athlete-exposures (AEs) (defined as practice or game participation) and shoulder and elbow injuries from the school years 2005-2006 through 2014-2015. Results: A total of 241 shoulder injuries and 150 elbow injuries occurred during 1,734,198 AEs during the study period, for an overall shoulder injury rate of 1.39 per 10,000 AEs and an overall elbow injury rate of 0.86 per 10,000 AEs. The overall rates of injury were higher in competitions compared with practices for shoulders (rate ratio, 1.44; 95% CI, 1.11-1.85) and elbows (rate ratio, 2.15; 95% CI, 1.56-2.96). The majority of shoulder (39.6%) and elbow (56.9%) injuries were sustained by pitchers, and most injuries were chronic and caused by overuse. Position players were more likely to sustain injuries by contact with the playing surface or apparatus. For pitchers, muscle strains were the most common shoulder injuries (38.7%), while ligament sprains were the most common elbow injuries (42.7%). The majority of pitchers with shoulder (70.8%) and elbow (64.6%) injuries returned to play within 21 days. Among pitchers, a higher proportion of elbow injuries (11.4%) resulted in medical disqualification compared with shoulder injuries (5.6%). Among pitchers, the majority of shoulder (89.2%) and elbow (96.4%) injuries were managed nonsurgically. Conclusion: Shoulder and elbow injury rates and patterns in high school baseball players differed between field positions (pitchers vs position players) and by type of exposure (practice vs competition). This study suggests several areas of emphasis for targeted injury prevention interventions, most notably limiting fatigue and preventing overuse injuries.

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Humeral Retroversion and Injury Risk After Proximal Humeral Epiphysiolysis (Little Leaguer’s Shoulder)

The American Journal of Sports Medicine ◽

10.1177/0363546519876060 ◽

2019 ◽

Vol 47 (13) ◽

pp. 3100-3106 ◽

Cited By ~ 2

Author(s):

Atsushi Ito ◽

Teruhisa Mihata ◽

Yuji Hosokawa ◽

Akihiko Hasegawa ◽

Masashi Neo ◽

...

Keyword(s):

High School ◽

Junior High School ◽

Junior High ◽

Control Group ◽

Baseball Players ◽

Elbow Pain ◽

Elbow Injury ◽

Elbow Injuries ◽

Little Leaguer’S Shoulder ◽

Humeral Retroversion

Background: The increased humeral retroversion on the dominant side of throwing athletes is thought to result from repetitive throwing motion. Little Leaguer’s shoulder—a rotational stress fracture of the proximal humeral epiphyseal plate—may influence the risk of humeral retroversion and injury of the shoulder or elbow joint. Purpose: To investigate the effect of Little Leaguer’s shoulder on humeral retroversion and the rates of shoulder and elbow injuries. Study Design: Cohort study; Level of evidence, 3. Methods: 10 high school baseball players (average age, 16.6 years; range, 16-18 years) who had experienced Little Leaguer’s shoulder during elementary or junior high school (average age, 12.6 years; range, 11-15 years) were enrolled in the study. As a control group, 22 high school baseball players (average age, 16.9 years; range, 16-18 years) who had never had any shoulder or elbow injury during elementary and junior high school were included. Humeral retroversion on ultrasonographic measurement, shoulder range of motion, and rates of shoulder and elbow injuries were evaluated. Results: Humeral retroversion was significantly greater on the dominant side than on the nondominant side in both players with Little Leaguer’s shoulder (dominant, 104°± 8°; nondominant, 84°± 12°; P < .001) and controls (dominant, 91°± 13°; nondominant, 81°± 10°; P < .001). In the dominant shoulder, humeral retroversion was greater in the Little Leaguer’s shoulder group than in the control group ( P = .008). When the effects of humeral retroversion were excluded, maximal external rotation was significantly less in the dominant shoulder than in the nondominant shoulder in the Little Leaguer’s shoulder group (by 11°± 12°, P = .02), whereas no significant difference was found between dominant (110°± 11°) and nondominant (111°± 13°) shoulders in the control group ( P = .64). The rates of shoulder and elbow pain were significantly higher in the Little Leaguer’s shoulder group (shoulder pain 80%, elbow pain 70%) than in the control group (shoulder pain 9%, P < .001; elbow pain 32%, P = .04). Conclusion: Humeral retroversion was increased in baseball players without any history of shoulder or elbow injury during elementary and junior high school and was further increased in players who had had Little Leaguer’s shoulder. Increased humeral retroversion after Little Leaguer’s shoulder may be a risk factor for future shoulder or elbow injury.

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A small number of daily pitches induces shoulder and elbow injuries among high school baseball pitchers: a prospective study

Scientific Reports ◽

10.1038/s41598-020-78957-0 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Hitoshi Shitara ◽

Tsuyoshi Tajika ◽

Takuro Kuboi ◽

Tsuyoshi Ichinose ◽

Tsuyoshi Sasaki ◽

...

Keyword(s):

Risk Factors ◽

High School ◽

Prospective Study ◽

Baseball Players ◽

Arm Injuries ◽

Elbow Injuries ◽

Full Power ◽

Baseball Pitchers ◽

A Prospective Study ◽

The Relationship

AbstractBaseball players frequently injure their shoulders and elbows. Preseason risk factors for such injuries have been relatively well studied, but in-season risk factors are less known, and the relationship between the number of pitches and the incidence of such injuries in baseball pitchers of any level is unclear. Identifying the risk factors related to the number of daily pitches is particularly important to prevent baseball-related arm injuries among young pitchers. Thus, we prospectively investigated the relationship between the number of daily full-power pitches in high school baseball pitchers and the incidence of shoulder and elbow injuries. We observed that a small number of daily full-power pitches, < 30 pitches per day, in high school baseball pitchers, significantly increased the risk of shoulder and elbow injuries: these players had a 2.3-times greater risk of injuries and a 45-day earlier occurrence of injuries than those pitching ≥ 30 pitches per day. Although unexpected, this was plausible as continuous daily pitching is required to maintain physical condition in growing and maturing high school pitchers. These findings may form the basis for establishing guidelines regarding the appropriate number of daily pitches required to prevent shoulder and elbow injuries in high school baseball pitchers.

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Shoulder Range of Motion Measures as Risk Factors for Shoulder and Elbow Injuries in High School Softball and Baseball Players

The American Journal of Sports Medicine ◽

10.1177/0363546511408876 ◽

2011 ◽

Vol 39 (9) ◽

pp. 1997-2006 ◽

Cited By ~ 169

Author(s):

Ellen Shanley ◽

Mitchell J. Rauh ◽

Lori A. Michener ◽

Todd S. Ellenbecker ◽

J. Craig Garrison ◽

...

Keyword(s):

Risk Factors ◽

High School ◽

Range Of Motion ◽

Baseball Players ◽

Shoulder Range Of Motion ◽

Elbow Injuries ◽

Shoulder Range

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Changes in Throwing Arm Mechanics at Increased Throwing Distances During Structured Long-Toss

The American Journal of Sports Medicine ◽

10.1177/0363546518795892 ◽

2018 ◽

Vol 46 (12) ◽

pp. 3002-3006 ◽

Cited By ~ 9

Author(s):

Brittany Dowling ◽

Michael P. McNally ◽

Walter A. Laughlin ◽

James A. Onate

Keyword(s):

High School ◽

Sports Medicine ◽

Inertial Sensor ◽

External Rotation ◽

Return To Play ◽

Baseball Players ◽

Shoulder Range Of Motion ◽

Elbow Injuries ◽

Shoulder External Rotation ◽

Throw Distance

Background: Elbow injuries among adolescent baseball players have been outpacing those of college and professional players. In attempts to prevent injuries and maximize return-to-play potential following injury, attention has been focused on “return to throw” programs, which include long-toss throws. Because the few studies that were conducted on long-toss throwing focused primarily on college-aged athletes, it is not known what type of load is incurred at the elbow during interval throwing progression among high school baseball players. Purpose: To quantify the change in arm slot, arm speed, shoulder external rotation, and elbow varus torque across increasing throwing distances within a given athlete. Study Design: Descriptive laboratory study. Methods: Ninety-five high school baseball players performed a long-toss protocol while wearing an inertial sensor and sleeve. Each participant was tested for 5 throws at distances of 9 m, 18 m, 27 m, 37 m, and 46 m. Linear mixed-effects models and likelihood ratio tests were used to estimate the within-participant relationship between throw distance and arm slot, arm speed, shoulder external rotation, and elbow varus torque. Results: Arm slot ( P < .01), arm speed ( P < .01), shoulder external rotation ( P < .01), and elbow varus torque ( P < .01) were significantly associated with long-toss throw distance. As the throw distance increased, there was an increase in arm speed and shoulder external rotation and a decrease in arm slot for each distance. However, elbow varus torque increased with each distance up to 37 m and then remained the same at 46 m. Conclusion: The use of longer distances for conditioning and rehabilitation may be beneficial in increasing shoulder range of motion and arm speed; however, precaution needs to be taken, as throwing longer distances are accompanied by an increase in arm rotation, arm speed, and elbow torque, with a decrease in arm slot. Clinical Relevance: Return-to-throw programs have been utilized by sports medicine clinicians and coaches to help guide a player during rehabilitation. These programs involve throwing at increased efforts through increased distances with no immediate feedback on elbow stress. This investigation describes arm biomechanical changes during submaximum interval throwing and demonstrates a tool that can be utilized to measure arm stress in real time for clinicians and athletes progressing through an interval throwing program.

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Early Sports Specialization Is Associated With Upper Extremity Injuries in Throwers and Fewer Games Played in Major League Baseball

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119861101 ◽

2019 ◽

Vol 7 (7) ◽

pp. 232596711986110 ◽

Cited By ~ 5

Author(s):

Jamie Confino ◽

James N. Irvine ◽

Michaela O’Connor ◽

Christopher S. Ahmad ◽

T. Sean Lynch

Keyword(s):

High School ◽

Upper Extremity ◽

Major League Baseball ◽

Professional Baseball ◽

Baseball Players ◽

Minor League ◽

Major League ◽

Elbow Injuries ◽

The Disabled ◽

Extremity Injuries

Background: Single-sport athletes who specialize in baseball at a young age may have a greater predisposition to overuse injury, burnout, and decreased career longevity when compared with multiple-sport athletes. The effect of sport specialization has not been studied in professional baseball players. Hypothesis: Major League Baseball (MLB) players who played multiple sports in high school would experience fewer injuries, spend less time on the disabled list, play more games, and have a longer career than athletes who played only baseball in high school. Study Design: Descriptive epidemiology study. Methods: First- and second-round MLB draft picks from 2008 to 2016 who played in at least 1 professional game were included in this study. Athletes who participated in 1 or more sports in addition to baseball during high school were considered multisport athletes, and athletes who participated in only baseball were considered single-sport athletes. For each athlete, participation in high school sports, injuries sustained in MLB and Minor League Baseball, number of days on the disabled list for each injury, number of games played in both leagues, and whether the athlete was still active were collected from publicly available records. Results: A total of 746 athletes were included in this study: 240 (32%) multisport and 506 (68%) single sport. Multisport athletes played in significantly more mean total games (362.8 vs 300.8; P < .01) as well as more mean MLB games (95.9 vs 71.6; P = .04) than single-sport athletes. There was no difference in the mean number of seasons played in the major leagues (1.8 vs 1.6; P = .15) or minor league (5.25 vs 5.20; P = .23) between multisport and single-sport athletes. Single-sport athletes had a significantly higher prevalence of upper extremity injuries compared with multisport athletes (136 [63%] vs 55 [50%]; P = .009). Single-sport pitchers also had a higher prevalence of shoulder and elbow injuries (86 vs 27; P = .008) and were more likely to have recurrent elbow injuries (33% vs 17% recurrence; P = .002) compared with multisport pitchers. Conclusion: Professional baseball players who participated in multiple sports in high school played in more major league games and experienced lower rates of upper and lower extremity injuries than players who played only baseball in high school.

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Early Sports Specialization is Associated with Increased Upper Extremity Injuries and Fewer Games Played in Major League Baseball Players

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00399 ◽

2019 ◽

Vol 7 (7_suppl5) ◽

pp. 2325967119S0039

Author(s):

Jamie Erica Confino ◽

James N. Irvine ◽

Christopher S. Ahmad ◽

Thomas Sean Lynch

Keyword(s):

High School ◽

Upper Extremity ◽

Sport Participation ◽

Sports Injuries ◽

Professional Baseball ◽

Baseball Players ◽

Major League ◽

Elbow Injuries ◽

The Disabled ◽

Extremity Injuries

Objectives: Early sport-specialization has been shown to place athletes at risk for increased injuries and decreased sporting performance in various sporting populations. However, the effect of sport-specialization has not been studied in professional baseball. The purpose of this investigation is to determine if single-sport athletes that specialize in baseball at a young age have a greater predisposition to overuse injury, burnout, and decreased performance compared to multiple-sport athletes. We hypothesized that MLB players who played multiple sports in high school would experience fewer injuries necessitating time on the Disabled List (DL), play more games, and have a longer career compared to athletes that played only baseball in high school. Methods: First and second-round MLB draft picks from 2008 to 2016 that played in at least one professional (minor or major league) game were included in this study. Athletes who participated in one or more sports in high school in addition to baseball were considered multi-sport athletes, and athletes who participated in only baseball were considered single-sport athletes. For each athlete, participation in high school sports, injuries sustained in MLB and MiLB, number of days on the Disabled List (DL) for each injury, number of games played in MLB and MiLB, and whether the athlete was still active were collected from publically available records. Results: Seven hundred forty-seven athletes were included in this study, of which 240 (32%) were multi-sport and 506 (68%) were single-sport athletes. Multi-sport athletes played in significantly more total professional baseball games on average (362.8 vs. 300.8, p < 0.01) as well as more major league games (95.9 vs. 71.6, p = 0.04) than single-sport athletes. Meanwhile, single-sport athletes had a significantly higher number of upper extremity injuries than multi-sport athletes (136 vs. 55, p < 0.01, Table I). Single-sport pitchers also had a higher number of shoulder and elbow injuries than multi-sport pitchers and, once injured, were more likely to have recurrent elbow injuries (86 vs. 27, p < 0.01; 33% vs. 17% recurrence). Conclusion: Professional baseball players who participated in multiple sports during high school played in more MLB games and sustained fewer upper extremity injuries than players who specialized in baseball before high school. Professional pitchers who specialized by the time they were in high school had a significantly higher chance of sustaining recurrent elbow injuries compared to those who were multi-sport athletes in high school. MLB players with a history of multi-sport participation were more likely to avoid overuse injuries and had greater longevity and level of performance compared to those that limited their sport participation to baseball during high school. [Table: see text]

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